Provider Demographics
NPI:1952450397
Name:COLLINS, JENNA LYNN (MS,EDS,NCC,LPC)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS,EDS,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5196
Mailing Address - Country:US
Mailing Address - Phone:828-301-5488
Mailing Address - Fax:828-586-5450
Practice Address - Street 1:398 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5196
Practice Address - Country:US
Practice Address - Phone:828-301-5488
Practice Address - Fax:828-586-5450
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103343Medicaid