=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003325002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID JAMES COLLINS MSW, LISW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2017
-----------------------------------------------------
Last Update Date | 10/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 E BROAD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-3988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-984-6805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1652 RHODA AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43212-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-571-6304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | I.1901707
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------