Healthcare Provider Details

I. General information

NPI: 1003705039
Provider Name (Legal Business Name): AMANDA LYNNE COLLINS BS, MS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WINTERSON RD STE 160
LINTHICUM MD
21090-2245
US

IV. Provider business mailing address

450 TRIMBLEFIELDS DR
EDGEWOOD MD
21040-3110
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax: 410-684-3973
Mailing address:
  • Phone: 410-688-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA01079
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA01079
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: