Provider Demographics
NPI:1881341642
Name:COLLINS, SALLY T (LPC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:T
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 1:67 BLUE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2315
Mailing Address - Country:US
Mailing Address - Phone:860-989-5955
Mailing Address - Fax:
Practice Address - Street 1:998 FARMINGTON AVE STE 214
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2184
Practice Address - Country:US
Practice Address - Phone:860-989-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health