Provider Demographics
NPI:1770608598
Name:WILLINGHAM, LYDIA (LPC - MHP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:LPC - MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 FOLKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5019
Mailing Address - Country:US
Mailing Address - Phone:803-331-1554
Mailing Address - Fax:
Practice Address - Street 1:1119 3RD AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5135
Practice Address - Country:US
Practice Address - Phone:803-394-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional