Healthcare Provider Details

I. General information

NPI: 1396573085
Provider Name (Legal Business Name): ANDREA LYNN COLLINS PSYCHIATRIC TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 SOLANO WAY
CONCORD CA
94520-4700
US

IV. Provider business mailing address

2158 SOLANO WAY
CONCORD CA
94520-4700
US

V. Phone/Fax

Practice location:
  • Phone: 925-490-1029
  • Fax:
Mailing address:
  • Phone: 925-490-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT31498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: