Provider Demographics
NPI:1104981646
Name:LINDSEY, PETINA COLLIER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PETINA
Middle Name:COLLIER
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:2536 S OLD HIGHWAY 94
Mailing Address - Street 2:STE 220
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5612
Mailing Address - Country:US
Mailing Address - Phone:314-322-3326
Mailing Address - Fax:636-329-0934
Practice Address - Street 1:2536 S OLD HIGHWAY 94
Practice Address - Street 2:STE 220
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:314-322-3326
Practice Address - Fax:636-329-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2019-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL1490111241041C0700X
MO0056991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494653421Medicaid