Provider Demographics
NPI:1104611177
Name:COLLINS, TYNISHA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 LABROT LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8397
Mailing Address - Country:US
Mailing Address - Phone:313-401-3937
Mailing Address - Fax:
Practice Address - Street 1:8339 LABROT LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8397
Practice Address - Country:US
Practice Address - Phone:313-401-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011829A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical