Provider Demographics
NPI:1215308127
Name:COLLINS, JOHNNETTA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JOHNNETTA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 ROYAL DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5925
Mailing Address - Country:US
Mailing Address - Phone:678-571-0937
Mailing Address - Fax:
Practice Address - Street 1:1226 ROYAL DR SW
Practice Address - Street 2:SUITE 100
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5925
Practice Address - Country:US
Practice Address - Phone:678-571-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291734101YM0800X
GALPC008575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health