Individual
MARY COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, CSAC
Contact information
Practice address
20 S MAIN ST STE 21, JANESVILLE, WI 53545-3959
(608) 851-0348
(815) 737-8115
Mailing address
20759 BURR OAK RD, CAPRON, IL 61012-9616
(815) 482-2563
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16284-132
WI
101YP2500X
Professional Counselor
3943-226
WI
101YP2500X
Professional Counselor
Primary
7634-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100078408
—
WI
Enumeration date
04/23/2015
Last updated
01/22/2021
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