Individual
DR. BERNICE LAVERNE COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
605 VOGEL PL, EAST SAINT LOUIS, IL 62205-2132
(618) 482-7990
(618) 271-6853
Mailing address
605 VOGEL PL, EAST SAINT LOUIS, IL 62205-2132
(618) 482-7990
(618) 271-6853
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08272004
BLUE CROSS/BLUE SHIELD #
IL
Enumeration date
07/31/2006
Last updated
07/08/2007
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