Healthcare Provider Details

I. General information

NPI: 1174134233
Provider Name (Legal Business Name): MR. DENNIS CARL MCCOLLINS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 UNIVERSITY AVE
BERKELEY CA
94703-1422
US

IV. Provider business mailing address

3800 COOLIDGE AVE
OAKLAND CA
94602-3399
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-5251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: