Provider Demographics
NPI:1386778744
Name:COLLINS, VIRGINIA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BELLE DR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4631
Mailing Address - Country:US
Mailing Address - Phone:225-933-0142
Mailing Address - Fax:337-923-0363
Practice Address - Street 1:817 BELLE DR
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4631
Practice Address - Country:US
Practice Address - Phone:225-933-0142
Practice Address - Fax:337-923-0363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health