Provider Demographics
NPI:1497974679
Name:COLLINS, JAMESON CHAPPELL (MRC)
Entity Type:Individual
Prefix:MR
First Name:JAMESON
Middle Name:CHAPPELL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 ABBY LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4587
Mailing Address - Country:US
Mailing Address - Phone:443-614-4278
Mailing Address - Fax:
Practice Address - Street 1:77 SHOE HOUSE RD
Practice Address - Street 2:
Practice Address - City:HELLAM
Practice Address - State:PA
Practice Address - Zip Code:17406-8025
Practice Address - Country:US
Practice Address - Phone:717-755-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health