Provider Demographics
NPI:1548587728
Name:COLLINS, R DANDRIDGE (PH D)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:DANDRIDGE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W RITTENHOUSE SQ
Mailing Address - Street 2:SUITE 408
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5726
Mailing Address - Country:US
Mailing Address - Phone:215-790-9718
Mailing Address - Fax:215-790-2557
Practice Address - Street 1:210 W RITTENHOUSE SQ
Practice Address - Street 2:SUITE 408
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5726
Practice Address - Country:US
Practice Address - Phone:215-790-9718
Practice Address - Fax:215-790-2557
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP1600X, 103TF0200X, 106H00000X
PAPS-005244-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist