Provider Demographics
NPI:1356584684
Name:COLLINS, AINSLEY GRACE (LPC)
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:GRACE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50417 N 26TH DR
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-9679
Mailing Address - Country:US
Mailing Address - Phone:623-465-4489
Mailing Address - Fax:
Practice Address - Street 1:50417 N 26TH DR
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-9679
Practice Address - Country:US
Practice Address - Phone:623-465-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6964101YP2500X
AZ10715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional