Provider Demographics
NPI:1568730521
Name:COLLINS, DAWN R (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 TOWN CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:5775 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4447
Practice Address - Country:US
Practice Address - Phone:248-855-1540
Practice Address - Fax:248-855-2481
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI019027OtherMIDWEST MEDICAID
MI750910932OtherBCCHRY
MIXX19153OtherHEALTHPLUS
MI000260F7OtherHAP
MI750910932OtherBCFED
MI750910932OtherBCBS MEDICARE ADVANTAGE
MI750910932OtherBCTR
MI750910932OtherBCMI
MI750910932OtherBCOOS