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General NPI Number Information
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NPI Number | 1639107329
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Entity Type | Individual
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Provider Name | GARY TYRONE COLLINS MSW, LPC, CCAC
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 787 VIRGINIA AVE
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City | WELCH
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State | WV
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Zip | 24801-2341
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Country | US
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Telephone | 304-436-2106
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Fax | 304-436-6362
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Provider Business Mailing Address
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Address Line | 200 12TH STREET EXT
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City | PRINCETON
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State | WV
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Zip | 24740-2329
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Country | US
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Telephone | 304-425-9541
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Fax | 304-425-1332
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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 | 02-322
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1528
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License Number State | WV
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