Healthcare Provider Details

I. General information

NPI: 1235599135
Provider Name (Legal Business Name): GLORIA COLLEEN COLLINS EDD, LPC, NCC, BCTMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 GOVERNMENT ST
OCEAN SPRINGS MS
39564-3826
US

IV. Provider business mailing address

10721 EAGLE NEST RD
OCEAN SPRINGS MS
39564-9711
US

V. Phone/Fax

Practice location:
  • Phone: 228-369-8379
  • Fax:
Mailing address:
  • Phone: 225-936-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1823
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1823
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: