Provider Demographics
NPI:1679874440
Name:COLLINS, WANDA M (LPC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16001
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6700
Mailing Address - Country:US
Mailing Address - Phone:870-340-6607
Mailing Address - Fax:
Practice Address - Street 1:2200 FOWLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6115
Practice Address - Country:US
Practice Address - Phone:870-340-6607
Practice Address - Fax:870-520-6444
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1401001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health