Provider Demographics
NPI:1770875379
Name:COLLINS, LAVERNE HANES (LPC)
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:HANES
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 N BEECH LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1274
Mailing Address - Country:US
Mailing Address - Phone:404-704-2280
Mailing Address - Fax:888-269-9127
Practice Address - Street 1:1301 CAROLINA ST STE 114
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1090
Practice Address - Country:US
Practice Address - Phone:404-704-2280
Practice Address - Fax:888-269-9127
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006399101YP2500X
NC13664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional