Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 167456 | KY |
Y | 1041C0700X | Clinical Social Worker | 254816 | KY |
NPI | 1013030527 |
---|---|
Provider Name | Mr. Anthony B Collins |
First Address | Paducah, KY 42001-0713 |
Second Address | Paducah, KY 42001-0713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 25/08/2020 |