Provider Demographics
NPI:1629274766
Name:COLLINS, WANDA
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MASSACHUSETTS AVE NW
Mailing Address - Street 2:MGC 214
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-8001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 MASSACHUSETTS AVE NW
Practice Address - Street 2:MGC 214
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-8001
Practice Address - Country:US
Practice Address - Phone:202-885-3500
Practice Address - Fax:202-885-1397
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist