Provider Demographics
NPI:1154001295
Name:COLLINS, MICHELLE L (CADAC 2, ADULT PSS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CADAC 2, ADULT PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 SOLONA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3244
Mailing Address - Country:US
Mailing Address - Phone:502-341-8621
Mailing Address - Fax:
Practice Address - Street 1:1345 CORYDON RAMSEY RD NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2270
Practice Address - Country:US
Practice Address - Phone:812-269-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51352101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)