Healthcare Provider Details

I. General information

NPI: 1902275100
Provider Name (Legal Business Name): CHRISTOPHER RAY COLLINS LPC, LAC, CCGC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 02/04/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23515 HIGHWAY 190
MANDEVILLE LA
70448-7334
US

IV. Provider business mailing address

57660 KIMBERLY LN
SLIDELL LA
70460-3714
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-4107
  • Fax: 985-624-4123
Mailing address:
  • Phone: 985-445-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1078
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1525
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5115
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8018
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1525
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1078
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: