Provider Demographics
NPI:1255914032
Name:COLLINS, DOROTHY M (MA, CADC/CODP1)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, CADC/CODP1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 S MICHIGAN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3897
Mailing Address - Country:US
Mailing Address - Phone:312-522-9309
Mailing Address - Fax:
Practice Address - Street 1:4529 S MICHIGAN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3897
Practice Address - Country:US
Practice Address - Phone:312-522-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional