Healthcare Provider Details

I. General information

NPI: 1932210390
Provider Name (Legal Business Name): DENISE COLLINS LPCC, LICDC, CEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20690 LAKELAND BLVD
EUCLID OH
44119-3241
US

IV. Provider business mailing address

11475 GREY FRIAR WAY
CHARDON OH
44024-8350
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax: 216-404-1901
Mailing address:
  • Phone: 440-285-8442
  • Fax: 440-285-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0000904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: