Provider Demographics
NPI:1811388911
Name:COLLMAN-MURPHY, JACE REID (LCAS, CCS)
Entity Type:Individual
Prefix:MR
First Name:JACE
Middle Name:REID
Last Name:COLLMAN-MURPHY
Suffix:
Gender:M
Credentials:LCAS, CCS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:COLLMAN-MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1132 E FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4244
Mailing Address - Country:US
Mailing Address - Phone:704-307-0608
Mailing Address - Fax:
Practice Address - Street 1:1132 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4244
Practice Address - Country:US
Practice Address - Phone:704-307-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)