Provider Demographics
NPI:1285732032
Name:COLLINS, JOHN (JACK) JOSEPH (LCMHC)
Entity type:Individual
Prefix:
First Name:JOHN (JACK)
Middle Name:JOSEPH
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:481 MORRILL ST
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6501
Mailing Address - Country:US
Mailing Address - Phone:603-393-8876
Mailing Address - Fax:603-528-6401
Practice Address - Street 1:216 LAFAYETTE RD
Practice Address - Street 2:#206
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2445
Practice Address - Country:US
Practice Address - Phone:603-964-1700
Practice Address - Fax:603-964-1701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health