Individual
MONTIQUE S COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
729 W MALDONADO RD, PHOENIX, AZ 85041-6763
(602) 455-4626
(602) 455-2624
Mailing address
3620 W GLENDALE AVE, 16, PHOENIX, AZ 85051
(602) 455-4626
(602) 455-4624
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
6439857
AZ
385HR2055X
Child Mental Illness Respite Care
6439857
AZ
Other
Enumeration date
01/04/2018
Last updated
03/10/2020
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