Healthcare Provider Details

I. General information

NPI: 1487038725
Provider Name (Legal Business Name): BILLINGS COLLINS L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SANTA ROSA RD
HENRICO VA
23229-5105
US

IV. Provider business mailing address

1503 SANTA ROSA RD
HENRICO VA
23229-5105
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9100
  • Fax:
Mailing address:
  • Phone: 804-282-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: