Provider Demographics
NPI:1558629139
Name:COLLINS, OLIVIA (LCSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1103 HUDSON LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6066
Mailing Address - Country:US
Mailing Address - Phone:318-322-6500
Mailing Address - Fax:318-322-5118
Practice Address - Street 1:1103 HUDSON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6066
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:318-322-5118
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1319101YA0400X
LA96761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)