Provider Demographics
NPI:1497578124
Name:COLLINS, NICOLE ASHLEY (LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ASHLEY
Other - Last Name:HAPSHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PUBLIC SQ STE 600
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1704
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-961-3844
Practice Address - Street 1:820 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1639
Practice Address - Country:US
Practice Address - Phone:570-931-1148
Practice Address - Fax:570-961-3844
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140186104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker