Provider Demographics
NPI:1639809882
Name:COLLINS, LESIA MECHELLE
Entity Type:Individual
Prefix:
First Name:LESIA
Middle Name:MECHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5321
Mailing Address - Country:US
Mailing Address - Phone:270-438-9344
Mailing Address - Fax:
Practice Address - Street 1:2830 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5321
Practice Address - Country:US
Practice Address - Phone:270-438-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC95557893103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging