MEDICARE: MRS. ELZORA DARLENE COLLINS CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1637-132	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396910634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELZORA DARLENE COLLINS CSAC

Provider Business Mailing Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 123
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-264-4217
Fax Number	:	414-264-4218

Provider Business Practice Location Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 123
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-264-4217
Fax Number	:	414-264-4218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	06/21/2023

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