Individual
DEAVON LYNETTE COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
4906 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2325
(414) 270-4670
Mailing address
4906 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2325
(414) 270-4670
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4259
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4259
LPC-IT
WI
Enumeration date
03/30/2019
Last updated
03/30/2019
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