Healthcare Provider Details

I. General information

NPI: 1558629139
Provider Name (Legal Business Name): OLIVIA COLLINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIBBY WILBURN LCSW

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 HUDSON LN
MONROE LA
71201-6066
US

IV. Provider business mailing address

1103 HUDSON LN
MONROE LA
71201-6066
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-6500
  • Fax: 318-322-5118
Mailing address:
  • Phone: 318-322-6500
  • Fax: 318-322-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1319
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9676
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: