Provider Demographics
NPI:1841388006
Name:COLLINS, CHERYL J (LMHC, RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMHC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 SOARING EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3354
Mailing Address - Country:US
Mailing Address - Phone:518-461-2597
Mailing Address - Fax:
Practice Address - Street 1:10425 SOARING EAGLE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3354
Practice Address - Country:US
Practice Address - Phone:518-461-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001880101YM0800X
FLRN9262416163WA0400X
FLMH10337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)