Provider Demographics
NPI:1215648464
Name:COLLINS, SHEA L (MED)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:L
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:118 LEE PARKWAY DR STE 420
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0814
Mailing Address - Country:US
Mailing Address - Phone:234-401-0681
Mailing Address - Fax:
Practice Address - Street 1:118 LEE PARKWAY DR STE 420
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0814
Practice Address - Country:US
Practice Address - Phone:423-401-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health