Provider Demographics
NPI:1730137456
Name:GRAHAM, WENDY K (LPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GERVAIS ST
Mailing Address - Street 2:STE 150-258
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3066
Mailing Address - Country:US
Mailing Address - Phone:803-361-3066
Mailing Address - Fax:866-834-4286
Practice Address - Street 1:1821 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2630
Practice Address - Country:US
Practice Address - Phone:803-361-3066
Practice Address - Fax:866-834-4286
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4644101YP2500X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered283Q00000XHospitalsPsychiatric Hospital