Provider Demographics
NPI:1851892541
Name:COLLINS, KORTNI M (CDCA)
Entity Type:Individual
Prefix:
First Name:KORTNI
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 SILVER MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1919
Mailing Address - Country:US
Mailing Address - Phone:330-474-3188
Mailing Address - Fax:330-673-6663
Practice Address - Street 1:785 SILVER MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1919
Practice Address - Country:US
Practice Address - Phone:330-474-3188
Practice Address - Fax:330-673-6663
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)