Provider Demographics
NPI:1790419851
Name:COLLS, VICKI K
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:K
Last Name:COLLS
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 1:634 LIVINGSTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31771-4203
Mailing Address - Country:US
Mailing Address - Phone:912-660-8227
Mailing Address - Fax:877-720-2715
Practice Address - Street 1:634 LIVINGSTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORMAN PARK
Practice Address - State:GA
Practice Address - Zip Code:31771-4203
Practice Address - Country:US
Practice Address - Phone:912-660-8227
Practice Address - Fax:877-720-2715
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171400000XOther Service ProvidersHealth & Wellness Coach
No251B00000XAgenciesCase Management