Provider Demographics
NPI:1609206572
Name:COLLINS, SAMANTHA CAROLE (CAADAC RRW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CAROLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CAADAC RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22110 ROSCOE BLVD
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3845
Mailing Address - Country:US
Mailing Address - Phone:818-713-8700
Mailing Address - Fax:818-713-8585
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:SUITE # 204
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-713-8700
Practice Address - Fax:818-713-8585
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)