Provider Demographics
NPI:1124995196
Name:COLLINS, CHESSIE DENISE
Entity type:Individual
Prefix:
First Name:CHESSIE
Middle Name:DENISE
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 1:268 CHAPELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-1404
Mailing Address - Country:US
Mailing Address - Phone:304-228-3212
Mailing Address - Fax:
Practice Address - Street 1:268 CHAPELWOOD DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-1404
Practice Address - Country:US
Practice Address - Phone:304-228-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency