Provider Demographics
NPI:1669822821
Name:COLLINS, PAMELA ELAINE (LCADC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELAINE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 GREENSBURG RD.
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404
Mailing Address - Country:US
Mailing Address - Phone:301-730-0133
Mailing Address - Fax:
Practice Address - Street 1:2883 GREENSBURG RD.
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404
Practice Address - Country:US
Practice Address - Phone:301-730-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)