Provider Demographics
NPI:1366183501
Name:COLLINS, TIMOTHY RAND II (TCADC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAND
Last Name:COLLINS
Suffix:II
Gender:M
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2501
Mailing Address - Country:US
Mailing Address - Phone:150-222-9787
Mailing Address - Fax:
Practice Address - Street 1:140 KINGS DAUGHTERS DR STE 400
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4242
Practice Address - Country:US
Practice Address - Phone:502-219-2603
Practice Address - Fax:502-699-2890
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)