Healthcare Provider Details

I. General information

NPI: 1801707021
Provider Name (Legal Business Name): LILLIAN RAE COLLINS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E KILGORE RD
PORTAGE MI
49002-0507
US

IV. Provider business mailing address

715 NORTH DR E
MARSHALL MI
49068-1287
US

V. Phone/Fax

Practice location:
  • Phone: 269-249-7179
  • Fax: 269-459-7149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: