Provider Demographics
NPI:1750952461
Name:COLLINS, ASHLEY NICHOLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16645 15 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2206
Mailing Address - Country:US
Mailing Address - Phone:586-213-5505
Mailing Address - Fax:586-213-5504
Practice Address - Street 1:16645 15 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2206
Practice Address - Country:US
Practice Address - Phone:586-213-5505
Practice Address - Fax:586-213-5504
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223629101YM0800X
MI6401019497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health