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General NPI Number Information
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NPI Number | 1386524411
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Entity Type | Individual
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Provider Name | DEMETRIA COLLINS
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 8225 S 59TH AVE
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City | LAVEEN
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State | AZ
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Zip | 85339-2886
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Country | US
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Telephone | 602-764-9037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11431
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City | MARINA DEL REY
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State | CA
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Zip | 90295-7431
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 132366
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 240226062
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 10247247
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License Number State | AZ
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