Healthcare Provider Details

I. General information

NPI: 1194058610
Provider Name (Legal Business Name): TERRI LYN COLLINS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRI LYN HOLLAND

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 HARFORD RD STE 6
BALTIMORE MD
21234-9205
US

IV. Provider business mailing address

7702 GAITHER RD
SYKESVILLE MD
21784-7123
US

V. Phone/Fax

Practice location:
  • Phone: 443-835-1167
  • Fax:
Mailing address:
  • Phone: 443-280-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: