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General NPI Number Information
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NPI Number | 1760843486
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Entity Type | Individual
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Provider Name | IAN GABRIEL COLLINS MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 8045 ARCO CORPORATE DR STE 120
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City | RALEIGH
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State | NC
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Zip | 27617-2026
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Country | US
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Telephone | 919-372-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 104 STOURBRIDGE CIR
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City | CARY
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State | NC
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Zip | 27511-4852
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Country | US
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Telephone | 336-404-2215
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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 | C012646
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 088671
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License Number State | NY
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