Provider Demographics
NPI:1184956393
Name:COLLINS, REBECCA E (LISW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1037
Mailing Address - Country:US
Mailing Address - Phone:614-725-3282
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST
Practice Address - Street 2:SUITE 300M
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3247
Practice Address - Country:US
Practice Address - Phone:614-594-7400
Practice Address - Fax:614-594-7202
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0800223104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker