Healthcare Provider Details

I. General information

NPI: 1548587728
Provider Name (Legal Business Name): R DANDRIDGE COLLINS PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W RITTENHOUSE SQ SUITE 408
PHILADELPHIA PA
19103-5726
US

IV. Provider business mailing address

210 W RITTENHOUSE SQ SUITE 408
PHILADELPHIA PA
19103-5726
US

V. Phone/Fax

Practice location:
  • Phone: 215-790-9718
  • Fax: 215-790-2557
Mailing address:
  • Phone: 215-790-9718
  • Fax: 215-790-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS-005244-L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: