Provider Demographics
NPI:1992759732
Name:COLLINS, DAVID A (LCSW, LCAS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 TULLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9032
Mailing Address - Country:US
Mailing Address - Phone:252-207-3660
Mailing Address - Fax:
Practice Address - Street 1:2367 TULLS CREEK RD
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-9032
Practice Address - Country:US
Practice Address - Phone:252-207-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC929101YA0400X
NCC0006841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1278KOtherBLUE CROSS BLUE SHIELD
NC6002300Medicaid