Provider Demographics
NPI:1134924574
Name:COLLINS, DYLAN (LCMHC-A)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 TOPSAIL LN APT L
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6568
Mailing Address - Country:US
Mailing Address - Phone:980-329-6186
Mailing Address - Fax:
Practice Address - Street 1:3804 WRIGHTSVILLE AVE UNIT 24
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6219
Practice Address - Country:US
Practice Address - Phone:910-788-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health