Provider Demographics
NPI:1073952164
Name:COLLINS, CASSAUNDRA A (LCSW)
Entity type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSY
Other - Middle Name:A
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2504 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0198
Mailing Address - Country:US
Mailing Address - Phone:208-731-7113
Mailing Address - Fax:
Practice Address - Street 1:2647 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7976
Practice Address - Country:US
Practice Address - Phone:208-734-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-353051041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical