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General NPI Number Information
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NPI Number | 1780195339
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Entity Type | Organization
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Legal Business Name | RACHEL COLLINS, LPC
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Dates
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Enumeration Date | 10/22/2017
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Last Update Date | 10/22/2017
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Provider Practice Location Address
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Address Line | 410 STATE ST RM 1
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3149
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Country | US
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Telephone | 203-809-6774
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Fax | 203-774-1200
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Provider Business Mailing Address
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Address Line | 4 S MAIN ST UNIT 6160
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City | WALLINGFORD
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State | CT
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Zip | 06492-7772
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Country | US
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Telephone | 203-809-6774
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Fax | 203-774-1200
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL COLLINS
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Credential | LPC
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Telephone | 203-809-6774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 002524
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License Number State | CT
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