Provider Demographics
NPI:1669693800
Name:COLLINS, LINDA LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOUISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4111
Mailing Address - Country:US
Mailing Address - Phone:619-296-7757
Mailing Address - Fax:619-542-0324
Practice Address - Street 1:3707 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4111
Practice Address - Country:US
Practice Address - Phone:619-296-7757
Practice Address - Fax:619-542-0324
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16251103TC0700X
CAMFC16251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist