Provider Demographics
NPI:1639572944
Name:COLLINS, JULIAN (TSS)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:TSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3422
Mailing Address - Country:US
Mailing Address - Phone:215-251-8089
Mailing Address - Fax:
Practice Address - Street 1:8119 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3422
Practice Address - Country:US
Practice Address - Phone:215-251-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor