Provider Demographics
NPI:1154545143
Name:COLLINS, JENNIFER CHRISTINE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
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 1:2075 E LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9607
Mailing Address - Country:US
Mailing Address - Phone:209-858-1075
Mailing Address - Fax:209-858-9593
Practice Address - Street 1:8026 LORRAINE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4224
Practice Address - Country:US
Practice Address - Phone:209-644-6328
Practice Address - Fax:209-644-6308
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)