Provider Demographics
NPI:1194058610
Name:COLLINS, TERRI LYN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7702 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7123
Mailing Address - Country:US
Mailing Address - Phone:443-280-2227
Mailing Address - Fax:
Practice Address - Street 1:8109 HARFORD RD STE 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9205
Practice Address - Country:US
Practice Address - Phone:443-835-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD039961200Medicaid