1447398730 NPI number — MRS. AMALIA CHRISTEEN COLLINS ACSW BCD LCSW

Table of content: MRS. AMALIA CHRISTEEN COLLINS ACSW BCD LCSW (NPI 1447398730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447398730 NPI number — MRS. AMALIA CHRISTEEN COLLINS ACSW BCD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
AMALIA
Provider Middle Name:
CHRISTEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACSW BCD LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
AMALIA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447398730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-9054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3169 2ND AVENUE EAST
Provider Second Line Business Practice Location Address:
WISE COUNTY BEHAVIORAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
BIG STONE GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-523-8319
Provider Business Practice Location Address Fax Number:
276-523-6964
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  0904002898 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 800002437 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010149584 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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