Provider Demographics
NPI:1700835352
Name:COLLINS, EDDIE LEE JR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:LEE
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 DAY BRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7236
Mailing Address - Country:US
Mailing Address - Phone:941-348-4059
Mailing Address - Fax:
Practice Address - Street 1:4143 DAY BRIDGE PL
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7236
Practice Address - Country:US
Practice Address - Phone:941-348-4059
Practice Address - Fax:418-034-2159
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8552101YM0800X
FLMH-8552101YA0400X
FLMH 8552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL756291800Medicaid
FL767380900Medicaid