Provider Demographics
NPI:1962918029
Name:COLLINS, MICHAEL ROBERT ANDRE (MS, LPCC LICDC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT ANDRE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MS, LPCC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2516
Mailing Address - Country:US
Mailing Address - Phone:513-518-5596
Mailing Address - Fax:844-782-3383
Practice Address - Street 1:434 FOREST AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2516
Practice Address - Country:US
Practice Address - Phone:513-518-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161617101YA0400X
101YM0800X, 171M00000X
OHC.1801263101YP2500X
OHE.2303618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator