Provider Demographics
NPI:1104883602
Name:COLLINS, LAWRENCE JOSEPH (LLP)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-4335
Mailing Address - Fax:248-465-4535
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-465-4335
Practice Address - Fax:248-465-4535
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist