Provider Demographics
NPI:1003705039
Name:COLLINS, AMANDA LYNNE (BS, MS, MA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BS, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TRIMBLEFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3110
Mailing Address - Country:US
Mailing Address - Phone:410-688-5739
Mailing Address - Fax:
Practice Address - Street 1:1190 WINTERSON RD STE 160
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2245
Practice Address - Country:US
Practice Address - Phone:410-684-3806
Practice Address - Fax:410-684-3973
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01079390200000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist