Provider Demographics
NPI:1780483529
Name:COLLINS, JAMES D (LAC,LCADC, CCS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:
Credentials:LAC,LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHARTER OAK ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2204
Mailing Address - Country:US
Mailing Address - Phone:201-279-2194
Mailing Address - Fax:201-279-2194
Practice Address - Street 1:28 CHARTER OAK ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2204
Practice Address - Country:US
Practice Address - Phone:201-279-2194
Practice Address - Fax:201-279-2194
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00429400101YM0800X
NJ37LC00303000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health