Healthcare Provider Details

I. General information

NPI: 1780242602
Provider Name (Legal Business Name): ASHLEY BRITTANY COLLINS LAC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3130
US

IV. Provider business mailing address

115 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3130
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACB.0008457
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0998457
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.00001651
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0015947
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016919
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: