Provider Demographics
NPI:1699181289
Name:COLLINS, DEMETRIA
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
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 1:1401 N MICHAEL WAY APT 148
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-1460
Mailing Address - Country:US
Mailing Address - Phone:702-480-1031
Mailing Address - Fax:
Practice Address - Street 1:4000 E CHARLESTON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6681
Practice Address - Country:US
Practice Address - Phone:702-968-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-11381041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8665-COtherSTATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS
NVIC-1138OtherSTATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS
NV6876-SOtherSTATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS