Provider Demographics
NPI:1396910634
Name:COLLINS, ELZORA DARLENE (CSAC)
Entity type:Individual
Prefix:MRS
First Name:ELZORA
Middle Name:DARLENE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 N VEL R PHILLIPS AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2370
Mailing Address - Country:US
Mailing Address - Phone:414-264-4217
Mailing Address - Fax:414-264-4218
Practice Address - Street 1:2821 N VEL R PHILLIPS AVE STE 123
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2370
Practice Address - Country:US
Practice Address - Phone:414-264-4217
Practice Address - Fax:414-264-4218
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1637-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39175500Medicaid