Individual
NICOLE DANIELLE COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3925 E BROADWAY RD STE 200, PHOENIX, AZ 85040-2977
(602) 690-6901
Mailing address
10755 E MEDINA AVE, MESA, AZ 85209-3212
(480) 825-8285
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
3747A0650X
Attendant Care Provider
291908
MO
Other
Enumeration date
09/04/2023
Last updated
10/27/2023
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