Provider Demographics
NPI:1396573085
Name:COLLINS, ANDREA LYNN (PSYCHIATRIC TECH)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PSYCHIATRIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 SOLANO WAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4700
Mailing Address - Country:US
Mailing Address - Phone:925-490-1029
Mailing Address - Fax:
Practice Address - Street 1:2158 SOLANO WAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4700
Practice Address - Country:US
Practice Address - Phone:925-490-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT31498167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician