Provider Demographics
NPI:1588825632
Name:COLLINS, LISA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2352
Mailing Address - Country:US
Mailing Address - Phone:630-267-0999
Mailing Address - Fax:
Practice Address - Street 1:5610 LENOX RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2352
Practice Address - Country:US
Practice Address - Phone:630-267-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490105621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical