Healthcare Provider Details

I. General information

NPI: 1407396583
Provider Name (Legal Business Name): JACQUELINE COLLINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 JEFFERSON ST NE STE 100
ALBUQUERQUE NM
87109-3485
US

IV. Provider business mailing address

5411 JEFFERSON ST NE STE 100
ALBUQUERQUE NM
87109-3485
US

V. Phone/Fax

Practice location:
  • Phone: 844-743-8506
  • Fax:
Mailing address:
  • Phone: 844-743-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: