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General NPI Number Information
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NPI Number | 1720547649
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Entity Type | Individual
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Provider Name | NICOLE YVONNE COLLINS MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 3125 POPLARWOOD CT STE 300
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City | RALEIGH
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State | NC
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Zip | 27604-6445
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Country | US
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Telephone | 919-790-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 4348 N CHICKEN RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8155
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Country | US
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Telephone | 910-501-9830
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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 | P012661
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License Number State | NC
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