Provider Demographics
NPI:1265083489
Name:COLLINS, MALISSA YVETTE (LPC)
Entity type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:YVETTE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 FURYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9506
Mailing Address - Country:US
Mailing Address - Phone:762-994-6792
Mailing Address - Fax:706-739-7221
Practice Address - Street 1:470 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9506
Practice Address - Country:US
Practice Address - Phone:762-994-6792
Practice Address - Fax:706-739-7221
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty