Provider Demographics
NPI:1851803480
Name:COLLINS, JAMILLE D (LCDC III)
Entity Type:Individual
Prefix:
First Name:JAMILLE
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1028
Mailing Address - Country:US
Mailing Address - Phone:513-254-0310
Mailing Address - Fax:
Practice Address - Street 1:2368 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2859
Practice Address - Country:US
Practice Address - Phone:513-254-0310
Practice Address - Fax:513-254-0310
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162380101YA0400X
OHS.2207441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)