Healthcare Provider Details

I. General information

NPI: 1023660339
Provider Name (Legal Business Name): MS. MARIA COLLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW 135TH AVE APT C105
PEMBROKE PINES FL
33027-1632
US

IV. Provider business mailing address

7770 REGENTS RD STE 113-382
SAN DIEGO CA
92122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 786-474-4692
  • Fax:
Mailing address:
  • Phone: 305-833-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23430
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1759
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: