Basic Information
| Provider Information | |||||||||
| NPI: | 1720396559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ALICE | ||||||||
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| Credential: | RDN, LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 N LONGFELLOW ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222052202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033886291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3020 14TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027454300 | ||||||||
| FaxNumber: | 2025488600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 08/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 002478 | CT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | 260678 | MD | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | LC4486 | MD | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 0701005962 | VA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | LC4486 | MD | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LC4486 | MD | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | LC4486 | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 133N00000X | 000982 | CT | N | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | DX3278 | MD | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | 887998 | MD | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 101YM0800X | PRC14452 | DC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 133NN1002X | NU134 | DC | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
ID Information
| ID | Type | State | Issuer | Description | 27-3463379 | 01 | TAX ID | OTHER | 1720396559 | 05 | DC | MEDICAID | 46-1239209 | 01 | TAX ID FOR NUTRITION | OTHER |