Individual
GEORGETTEA M. COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1311 2ND ST, PORTSMOUTH, OH 45662-4602
(740) 354-1010
Mailing address
PO BOX 226, WAVERLY, OH 45690-0226
(740) 947-6727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.171326
OH
101YM0800X
Mental Health Counselor
QMHS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0305672
—
OH
Enumeration date
05/10/2018
Last updated
03/09/2020
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