Provider Demographics
NPI:1558326132
Name:COLLINS, MELINDA D (PHD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9868 OXFORD STATION DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3232
Mailing Address - Country:US
Mailing Address - Phone:267-978-8660
Mailing Address - Fax:
Practice Address - Street 1:9868 OXFORD STATION DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3232
Practice Address - Country:US
Practice Address - Phone:267-978-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical