Healthcare Provider Details

I. General information

NPI: 1164461471
Provider Name (Legal Business Name): ROBERT P COLLINS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHARON AMITY RD SUITE 500
CHARLOTTE NC
28211-2896
US

IV. Provider business mailing address

501 S SHARON AMITY RD SUITE 500
CHARLOTTE NC
28211-2896
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-1555
  • Fax: 704-362-0023
Mailing address:
  • Phone: 704-362-1555
  • Fax: 704-362-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number843
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: