MEDICARE: MR. TERENCE DREW COLLINS I MA, LGPC

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	101YP2500X	Professional Counselor	LGP10530	MD

General Provider Information

NPI Number	:	1720682818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERENCE DREW COLLINS I MA, LGPC

Provider Business Mailing Address
First Line	:	8711 EAST GRV
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-2447
Country	:	US
Telephone Number	:	240-271-7448
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 WALKER MILL RD
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4503
Country	:	US
Telephone Number	:	240-271-7448
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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