Provider Demographics
NPI:1376998815
Name:WINGARD, PAULETTE COTHREN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:COTHREN
Last Name:WINGARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:PAULETTE
Other - Last Name:COTHREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-0039
Mailing Address - Country:US
Mailing Address - Phone:843-889-3462
Mailing Address - Fax:
Practice Address - Street 1:7783 MORRIS BING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5993
Practice Address - Country:US
Practice Address - Phone:843-889-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical