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General NPI Number Information
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NPI Number | 1477005189
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Entity Type | Individual
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Provider Name | MARK COLLINS JR.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 410 UNIVERSITY PKWY
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City | AIKEN
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State | SC
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Zip | 29801-6810
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Country | US
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Telephone | 803-645-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 BLUE SPRUCE DR
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City | GRANITEVILLE
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State | SC
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Zip | 29829-3980
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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