Provider Demographics
NPI:1669481982
Name:COLLINS, CARON (MFT, INTERN)
Entity Type:Individual
Prefix:MS
First Name:CARON
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MFT, INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 LINCOLNSHIRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2099
Mailing Address - Country:US
Mailing Address - Phone:916-282-1912
Mailing Address - Fax:916-282-1940
Practice Address - Street 1:14000 S MILITARY TRL STE 204A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2654
Practice Address - Country:US
Practice Address - Phone:561-501-5260
Practice Address - Fax:916-282-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 40272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40272OtherBBS IMF #
CA3485OtherSACRAMENTO LPHA COUNTY D