Provider Demographics
NPI:1225561988
Name:WALLACH, H (LPC)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:
Last Name:WALLACH
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 1:1381 LURECLIFF PL
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7956
Mailing Address - Country:US
Mailing Address - Phone:704-968-7499
Mailing Address - Fax:
Practice Address - Street 1:1381 LURECLIFF PL
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7956
Practice Address - Country:US
Practice Address - Phone:704-968-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6413101YP2500X
NC11061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional