Provider Demographics
NPI:1821122003
Name:WILSON, SARAH PAMELA (LPC, NCC, MAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:PAMELA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 WILMOT AVE.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205
Mailing Address - Country:US
Mailing Address - Phone:803-206-2620
Mailing Address - Fax:
Practice Address - Street 1:2210 DEVINE ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205
Practice Address - Country:US
Practice Address - Phone:803-206-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional