Provider Demographics
NPI:1336302538
Name:JOURNEY FORWARD
Entity Type:Organization
Organization Name:JOURNEY FORWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPC
Authorized Official - Phone:803-479-1027
Mailing Address - Street 1:742 CINDY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5206
Mailing Address - Country:US
Mailing Address - Phone:803-479-1027
Mailing Address - Fax:866-344-1607
Practice Address - Street 1:2611 FOREST DR
Practice Address - Street 2:SUITE 129
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2379
Practice Address - Country:US
Practice Address - Phone:803-251-0104
Practice Address - Fax:866-344-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty