Individual
DIVVIA-CLYNE ASHLEY COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
148 WILSHIRE BLVD, CASSELBERRY, FL 32707-5372
(321) 972-4039
Mailing address
1513 LEONE LN, PORT ORANGE, FL 32129-4079
(386) 679-4554
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-17-7834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018980700
—
FL
Enumeration date
12/27/2018
Last updated
04/08/2019
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