MEDICARE: DEMETRIA COLLINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	IC-1138	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8665-C	OTHER	NV	STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS
2	IC-1138	OTHER	NV	STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS
3	6876-S	OTHER	NV	STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS

General Provider Information

NPI Number	:	1699181289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIA COLLINS

Provider Business Mailing Address
First Line	:	1401 N MICHAEL WAY APT 148
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1460
Country	:	US
Telephone Number	:	702-480-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 E CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6681
Country	:	US
Telephone Number	:	702-968-5059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	12/11/2019

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Directions to “ DEMETRIA COLLINS ” Practice Location

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