Provider Demographics
NPI:1538614953
Name:COLLINS, SHARDAE (LICSW)
Entity type:Individual
Prefix:
First Name:SHARDAE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 58TH AVE E APT E12
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1957
Mailing Address - Country:US
Mailing Address - Phone:323-404-4281
Mailing Address - Fax:
Practice Address - Street 1:7610 40TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3834
Practice Address - Country:US
Practice Address - Phone:253-830-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
CA78863390200000X
WALW61119779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program