Provider Demographics
NPI:1598181679
Name:COLLINS, MIA (MS, MSW, LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, MSW, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 LINCOLN HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1846
Mailing Address - Country:US
Mailing Address - Phone:708-503-1274
Mailing Address - Fax:708-503-1000
Practice Address - Street 1:2605 LINCOLN HWY
Practice Address - Street 2:SUITE 114
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1846
Practice Address - Country:US
Practice Address - Phone:708-503-1274
Practice Address - Fax:708-503-1000
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490165041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical