Provider Demographics
NPI:1033464870
Name:DAVIES, COLLIN THOMAS (MA, LPE-I)
Entity type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:THOMAS
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MA, LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 PRINCE ST STE 53
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3600
Mailing Address - Country:US
Mailing Address - Phone:501-764-3002
Mailing Address - Fax:866-514-7628
Practice Address - Street 1:2850 PRINCE ST STE 53
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3600
Practice Address - Country:US
Practice Address - Phone:501-764-3002
Practice Address - Fax:866-514-7628
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2109018101YP2500X
AR13-22EI103T00000X
AR171M00000X
AR13-22E103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator