Provider Demographics
NPI:1801116181
Name:COLLINS, ATIYA LARK (MCD CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ATIYA
Middle Name:LARK
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9793
Mailing Address - Country:US
Mailing Address - Phone:864-341-1279
Mailing Address - Fax:
Practice Address - Street 1:203 NORTH MAPLE STREET
Practice Address - Street 2:SUITE # 10
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-757-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist