Provider Demographics
NPI:1215287974
Name:COLLINS, MARY LEE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 SLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606
Mailing Address - Country:US
Mailing Address - Phone:251-473-3410
Mailing Address - Fax:251-476-4454
Practice Address - Street 1:1340 SLEDGE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606
Practice Address - Country:US
Practice Address - Phone:251-473-3410
Practice Address - Fax:251-476-4454
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional