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NPI Code Detail

MEDICARE: IAN GABRIEL COLLINS MSW, LCSW

MEDICARE: IAN GABRIEL COLLINS MSW, LCSW
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
11041C0700XClinical Social WorkerC012646NC
21041C0700XClinical Social Worker088671NY

General Provider Information

NPI Number : 1760843486
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN GABRIEL COLLINS MSW, LCSW
Provider Business Mailing Address
First Line : 104 STOURBRIDGE CIR
Second Line :
City : CARY
State : NC
Zip : 27511-4852
Country : US
Telephone Number : 336-404-2215
Fax Number :
Provider Business Practice Location Address
First Line : 8045 ARCO CORPORATE DR STE 120
Second Line :
City : RALEIGH
State : NC
Zip : 27617-2026
Country : US
Telephone Number : 919-372-3690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2016
Last Update Date : 03/25/2025

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