Provider Demographics
NPI:1609135193
Name:REYNOLDS, WENDE DANFORD (LPC)
Entity Type:Individual
Prefix:MRS
First Name:WENDE
Middle Name:DANFORD
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WENDE
Other - Middle Name:DANFORD
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2122 CHANCELLORY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6248
Mailing Address - Country:US
Mailing Address - Phone:843-830-1002
Mailing Address - Fax:888-975-5943
Practice Address - Street 1:1171 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4209
Practice Address - Country:US
Practice Address - Phone:843-830-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional