Healthcare Provider Details

I. General information

NPI: 1073370250
Provider Name (Legal Business Name): ASHEIKA DENAE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TOWER DR STE A
MONROE LA
71201-5045
US

IV. Provider business mailing address

206 CURVE DR APT 77
MONROE LA
71203-4253
US

V. Phone/Fax

Practice location:
  • Phone: 318-570-5403
  • Fax:
Mailing address:
  • Phone: 318-307-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLPC10114
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: