Provider Demographics
NPI:1558999607
Name:COLLINS, DELORES (C-CHN)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:C-CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 FARHILL RD C-349
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:216-703-2339
Mailing Address - Fax:
Practice Address - Street 1:10403 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3423
Practice Address - Country:US
Practice Address - Phone:216-703-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHFPS.000045101YM0800X
OHCHW000941172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health