Healthcare Provider Details

I. General information

NPI: 1477797660
Provider Name (Legal Business Name): PATSIE B COLLINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CRAMERTON RD
GASTONIA NC
28056-7306
US

IV. Provider business mailing address

455 CRAMERTON RD
GASTONIA NC
28056-7306
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-7625
  • Fax:
Mailing address:
  • Phone: 704-824-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: