Provider Information for 1790274512
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TATIANA LATRICE COLLINS LPC
Sex: Female
NPI: 1790274512
Last Updated: 2022-04-05
Certification Date: 2022-04-05
Certification Date: 2022-04-05
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790274512 | ||||||||||||
| Enumeration Date | 2018-05-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 404 SPRINGBORO LN COLUMBUS, OH 43235-5602 United States Phone: 614-779-3679 | Fax: | ||||||||||||
| Primary Practice Address | 700 CHILDREN'S DRIVE COLUMBUS, OH 43205 United States Phone: 614-722-3841 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1115 BETHEL RD | ||||||||||||
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