Healthcare Provider Details

I. General information

NPI: 1285826610
Provider Name (Legal Business Name): PAUL COLLINS MA. CAGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MANTON AVE
PROVIDENCE RI
02909-5633
US

IV. Provider business mailing address

1 TUPPERWARE DR UNIT 231
NORTH SMITHFIELD RI
02896-6866
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-6310
  • Fax:
Mailing address:
  • Phone: 401-965-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00326
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: