Provider Demographics
NPI:1922679273
Name:COLLINS, JENNIFER ELAIN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAIN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 DUVAL POINT WAY SW
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7623
Mailing Address - Country:US
Mailing Address - Phone:177-086-4664
Mailing Address - Fax:
Practice Address - Street 1:LITHONIA ABA THERAPY
Practice Address - Street 2:5461 HILLANDALE DRIVE
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:470-361-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst