Provider Demographics
NPI:1487141115
Name:COLLINS, EDWARD ALBERT (MA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALBERT
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 HOUSER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-8371
Mailing Address - Country:US
Mailing Address - Phone:248-881-3181
Mailing Address - Fax:
Practice Address - Street 1:3045 GRANGE HALL RD STE 300
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1020
Practice Address - Country:US
Practice Address - Phone:248-382-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008410103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling