Healthcare Provider Details

I. General information

NPI: 1205200136
Provider Name (Legal Business Name): JESSICA MARIE COLLINS M.ED., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PIGEON ROOST RD
RUSH KY
41168-8132
US

IV. Provider business mailing address

1351 NEWTOWN PIKE BLDG 1
LEXINGTON KY
40511-1277
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-6648
  • Fax:
Mailing address:
  • Phone: 859-253-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number173244
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number173244
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: