Provider Demographics
NPI:1780627935
Name:COLLINS, CAROL ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S SAN FRANCISCO ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5796
Mailing Address - Country:US
Mailing Address - Phone:928-774-2581
Mailing Address - Fax:928-773-1782
Practice Address - Street 1:519 N LEROUX ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3221
Practice Address - Country:US
Practice Address - Phone:928-774-2581
Practice Address - Fax:928-774-2581
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3773103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling