Provider Demographics
NPI:1679697551
Name:COLLINS, SUSAN MARY (MFCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFCC
Mailing Address - Street 1:1010 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1417
Mailing Address - Country:US
Mailing Address - Phone:415-479-6064
Mailing Address - Fax:415-472-1108
Practice Address - Street 1:1010 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1417
Practice Address - Country:US
Practice Address - Phone:415-479-6064
Practice Address - Fax:415-472-1108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist