Provider Demographics
NPI:1538299458
Name:COLLINS, DEIDRE (BA)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 W 93RD ST
Mailing Address - Street 2:#5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-7376
Mailing Address - Country:US
Mailing Address - Phone:310-365-8721
Mailing Address - Fax:
Practice Address - Street 1:5302 W 93RD ST
Practice Address - Street 2:#5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-7376
Practice Address - Country:US
Practice Address - Phone:310-365-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor