Provider Demographics
NPI:1841575594
Name:COLLINS, JESSICA BACH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BACH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:EMILY
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 PRESTON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-2614
Mailing Address - Country:US
Mailing Address - Phone:860-280-8649
Mailing Address - Fax:
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1534
Practice Address - Country:US
Practice Address - Phone:860-793-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0019740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health