Provider Demographics
NPI:1265644231
Name:WILTON L HELLAMS PHD
Entity Type:Organization
Organization Name:WILTON L HELLAMS PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HELLAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-699-1822
Mailing Address - Street 1:1 CHUKKER HILL CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8130
Mailing Address - Country:US
Mailing Address - Phone:803-699-1822
Mailing Address - Fax:803-699-1738
Practice Address - Street 1:9308 TWO NOTCH RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6401
Practice Address - Country:US
Practice Address - Phone:803-699-1822
Practice Address - Fax:803-699-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP9989Medicaid