Provider Demographics
NPI:1821030719
Name:COLLINS, TOM (PHD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PRESTON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5044
Mailing Address - Country:US
Mailing Address - Phone:434-242-0699
Mailing Address - Fax:434-244-3772
Practice Address - Street 1:300 PRESTON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5044
Practice Address - Country:US
Practice Address - Phone:434-242-0699
Practice Address - Fax:434-244-3772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical