Healthcare Provider Details

I. General information

NPI: 1871886572
Provider Name (Legal Business Name): BETTY RUTH COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S MAIN ST
CULPEPER VA
22701-3209
US

IV. Provider business mailing address

911 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5355
US

V. Phone/Fax

Practice location:
  • Phone: 540-829-4006
  • Fax: 540-829-0440
Mailing address:
  • Phone: 434-984-0023
  • Fax: 434-984-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002105
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: