Provider Demographics
NPI:1558602946
Name:WANNAMAKER, SABRINA L (MA, LPCMH, NCC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:L
Last Name:WANNAMAKER
Suffix:
Gender:F
Credentials:MA, LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DR
Mailing Address - Street 2:STE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2415
Mailing Address - Country:US
Mailing Address - Phone:803-546-4756
Mailing Address - Fax:888-397-4419
Practice Address - Street 1:724 JANICE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7826
Practice Address - Country:US
Practice Address - Phone:803-546-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2017-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-00000617101YM0800X
SC5621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health