Provider Demographics
NPI:1780195339
Name:RACHEL COLLINS, LPC
Entity Type:Organization
Organization Name:RACHEL COLLINS, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-809-6774
Mailing Address - Street 1:4 S MAIN ST UNIT 6160
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-7772
Mailing Address - Country:US
Mailing Address - Phone:203-809-6774
Mailing Address - Fax:203-774-1200
Practice Address - Street 1:410 STATE ST RM 1
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3149
Practice Address - Country:US
Practice Address - Phone:203-809-6774
Practice Address - Fax:203-774-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002524261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health