Basic Information
| Provider Information | |||||||||
| NPI: | 1689732323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLIER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 1ST AVE NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286016122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286955900 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 E PARKER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286555155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286241900 | ||||||||
| FaxNumber: | 8284386225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5389 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 5389 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1689732323 | 01 | NC | MEDCOST | OTHER | 6103451 | 05 | NC | MEDICAID | 600464-032 | 01 | NC | MAGELLAN | OTHER | 147PH | 01 | NC | BCBS | OTHER | 1689732323 | 01 | NC | TRICARE/HEALTH NET FEDERAL SVS | OTHER |