Provider Demographics
NPI:1558398925
Name:COLLINS, KATHLEEN LINDNER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LINDNER
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 GEOFFREY WAY
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3398
Mailing Address - Country:US
Mailing Address - Phone:336-416-3781
Mailing Address - Fax:
Practice Address - Street 1:201 N EUGENE ST STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2221
Practice Address - Country:US
Practice Address - Phone:336-389-6072
Practice Address - Fax:336-389-6126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102603Medicaid