Wanda Ivette Collazo, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

9258 Issued in NC

Practice address

590 Cedar Creek Rd
Suite 110
Fayetteville, NC 28312-6559

Phone

(910) 424-2020

Fax

(910) 424-8435

NPI assigned

Oct 10, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789689600000",
    "number": "1336491653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 SHAWCROFT RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283112934",
            "telephone_number": "910-424-2020",
            "fax_number": "910-424-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 CEDAR CREEK RD",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283126559",
            "telephone_number": "910-424-2020",
            "fax_number": "910-424-8435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "WANDA",
        "middle_name": "IVETTE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-10",
        "last_updated": "2026-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701011289",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "8324",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "92450",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "9258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Coles
• Harold Downey Coley IV
• Judith Coley, RD
• Kadie-Ann Coley
• Desire Collazo
• College Lakes
• Amanda Josephine Collett-Burgdorf, PHARMD
• Tori Collins-Newcombe, LCSWA, LCASA
• Amie N. Collins, MD
• Brittney Louis Collins, PHARMD

• Mental Health Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.