Provider Demographics
NPI:1518025733
Name:COLLINS-JACKSON, SANDRA (MS, LPC, CPRP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:COLLINS-JACKSON
Suffix:
Gender:F
Credentials:MS, LPC, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CENTER AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6393
Mailing Address - Country:US
Mailing Address - Phone:907-486-2632
Mailing Address - Fax:907-486-2732
Practice Address - Street 1:104 CENTER AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6393
Practice Address - Country:US
Practice Address - Phone:907-486-2632
Practice Address - Fax:907-486-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional