Provider Demographics
NPI:1104060599
Name:COLLINS, ELIZABETH A H
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A H
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:FOURTH FLOOR NW BUILDING
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1424
Mailing Address - Country:US
Mailing Address - Phone:937-276-8333
Mailing Address - Fax:937-276-8339
Practice Address - Street 1:601 S EDWIN C MOSES BLVD
Practice Address - Street 2:FOURTH FLOOR NW BUILDING
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1424
Practice Address - Country:US
Practice Address - Phone:937-276-8333
Practice Address - Fax:937-276-8339
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0700297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health