Provider Demographics
NPI:1790235703
Name:COLLINS, JANICE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 VILLAGE DR APT 349
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-8122
Mailing Address - Country:US
Mailing Address - Phone:773-983-3773
Mailing Address - Fax:
Practice Address - Street 1:12N393 WAUGHON RD
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-8426
Practice Address - Country:US
Practice Address - Phone:773-983-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150015582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker