Provider Demographics
NPI:1902275100
Name:COLLINS, CHRISTOPHER RAY (LPC, LAC, CCGC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LPC, LAC, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57660 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3714
Mailing Address - Country:US
Mailing Address - Phone:985-445-4763
Mailing Address - Fax:
Practice Address - Street 1:23515 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7334
Practice Address - Country:US
Practice Address - Phone:985-624-4107
Practice Address - Fax:985-624-4123
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5115101YA0400X
LA1525171M00000X, 324500000X
LA1078171M00000X, 324500000X
LA8018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility