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General NPI Number Information
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NPI Number | 1255368577
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Entity Type | Individual
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Provider Name | MICHELLE KAREN COLLINS PH D
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 1100 LOGGER CT SUITE 103G
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 888-983-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 LOGGER CT SUITE 103G
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City | RALEIGH
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State | NC
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Zip | 27609-8525
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Country | US
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Telephone | 888-983-7771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33009
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3438
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License Number State | NC
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