Provider Demographics
NPI:1720396559
Name:COLLINS, PATRICIA ALICE (RDN, LCPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ALICE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RDN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N LONGFELLOW ST APT 6
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2202
Mailing Address - Country:US
Mailing Address - Phone:703-388-6291
Mailing Address - Fax:
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-745-4300
Practice Address - Fax:202-548-8600
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002478101YM0800X
MD260678101Y00000X
MDLC4486101Y00000X, 101YA0400X, 101YM0800X
VA0701005962101YM0800X
LC4486101YP1600X
CT000982133N00000X
MDDX3278133N00000X
133NN1002X
MD887998133V00000X
DCPRC14452101YM0800X
DCNU134133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-3463379OtherTAX ID
DC1720396559Medicaid
46-1239209OtherTAX ID FOR NUTRITION