Provider Demographics
NPI:1306381892
Name:COLLIER, POLLY ANN (LAPC)
Entity type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:ANN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733B CARROLL STREET
Mailing Address - Street 2:
Mailing Address - City:PERY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-8423
Mailing Address - Country:US
Mailing Address - Phone:478-224-2850
Mailing Address - Fax:478-224-2850
Practice Address - Street 1:733 CARROLL ST
Practice Address - Street 2:SUITE B
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3368
Practice Address - Country:US
Practice Address - Phone:478-224-2850
Practice Address - Fax:478-224-2850
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional