| Entity Name: | DERRICK COLLINS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Sep 2017 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 10 Oct 2017 (7 years ago) |
| Document Number: | L17000198533 |
| FEI/EIN Number | 82-2900914 |
| Address: | 1615 RIDGEWOOD AVE, HOLLY HILL, FL, 32117, US |
| Mail Address: | 19 STARLING DR, DAYTONA BEACH, FL, 32117, US |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013682418 | 2021-08-09 | 2021-08-09 | 19 STARLING DR, DAYTONA BEACH, FL, 321171886, US | 1615 RIDGEWOOD AVE STE A, HOLLY HILL, FL, 321171749, US | |||||||||||||||||||||||||
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| Phone | +1 386-262-9852 |
Authorized person
| Name | DERRICK COLLINS |
| Role | OWNER |
| Phone | 3862629852 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 343900000X - Non-emergency Medical Transport (VAN) |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| COLLINS EL DERRICK | Agent | 19 STARLING DR, DAYTONA BEACH, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| COLLINS DERRICK | Manager | 19 STARLING DR, DAYTONA BEACH, FL, 32117 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000072787 | STRESS AND ANXIETY CENTER OF DAYTONA | ACTIVE | 2018-06-29 | 2028-12-31 | No data | 19 STARLING DR, DAYTONA BEACH, FL, 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-13 | 1615 RIDGEWOOD AVE, Unit LS & LN, HOLLY HILL, FL 32117 | No data |
| LC AMENDMENT | 2017-10-10 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-03-24 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-08 |
| ANNUAL REPORT | 2020-04-13 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-09 |
| LC Amendment | 2017-10-10 |
| Florida Limited Liability | 2017-09-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
