Provider Demographics
NPI:1760843486
Name:COLLINS, IAN GABRIEL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:GABRIEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STOURBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4852
Mailing Address - Country:US
Mailing Address - Phone:336-404-2215
Mailing Address - Fax:
Practice Address - Street 1:8045 ARCO CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-2026
Practice Address - Country:US
Practice Address - Phone:919-372-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0886711041C0700X
NCC0126461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical