Provider Demographics
NPI:1659763209
Name:COLLINS, ROSS ALAN
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:ALAN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PIEDMONT RD STE 5
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8285
Mailing Address - Country:US
Mailing Address - Phone:864-380-5231
Mailing Address - Fax:864-220-1102
Practice Address - Street 1:406 PIEDMONT RD STE 5
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-8285
Practice Address - Country:US
Practice Address - Phone:864-380-5231
Practice Address - Fax:864-220-1102
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional