Provider Demographics
NPI:1114342458
Name:NANNA, GLENDA KAY (LPC, LPCS)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:KAY
Last Name:NANNA
Suffix:
Gender:F
Credentials:LPC, LPCS
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:KAY
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 BOOKMAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9711
Mailing Address - Country:US
Mailing Address - Phone:843-789-9990
Mailing Address - Fax:
Practice Address - Street 1:810 DUTCH SQUARE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7318
Practice Address - Country:US
Practice Address - Phone:803-394-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4379101YP2500X
SC5473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional