Provider Demographics
NPI:1184259228
Name:KIRKLAND, WANDA (AADC)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 GABLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6475
Mailing Address - Country:US
Mailing Address - Phone:843-229-2355
Mailing Address - Fax:
Practice Address - Street 1:1578 CLARENCE COKER HWY
Practice Address - Street 2:
Practice Address - City:TURBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29162-9419
Practice Address - Country:US
Practice Address - Phone:803-896-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)