Basic Information
| Provider Information | |||||||||
| NPI: | 1952450397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS,EDS,NCC,LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287795196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283015488 | ||||||||
| FaxNumber: | 8285865450 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287795196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283015488 | ||||||||
| FaxNumber: | 8285865450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5283 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6103343 | 05 | NC | MEDICAID |