Provider Demographics
NPI:1790864817
Name:COLLINGS, JOHN EVERETT
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EVERETT
Last Name:COLLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:EVERETT
Other - Last Name:COLLINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CATC
Mailing Address - Street 1:101 AVENIDA SERRA
Mailing Address - Street 2:ATTN JOHN C.
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3472
Mailing Address - Country:US
Mailing Address - Phone:949-690-2829
Mailing Address - Fax:
Practice Address - Street 1:101 AVENIDA SERRA
Practice Address - Street 2:MAINSTREAM GROUP RECOVERY INC.
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3472
Practice Address - Country:US
Practice Address - Phone:949-366-9210
Practice Address - Fax:949-498-5706
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030763101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)