Provider Demographics
NPI:1780752956
Name:BURDEN, WANDA JEAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JEAN
Last Name:BURDEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 RICE MILL DR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8212
Mailing Address - Country:US
Mailing Address - Phone:843-452-7556
Mailing Address - Fax:
Practice Address - Street 1:4417 RICE MILL DR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8212
Practice Address - Country:US
Practice Address - Phone:843-452-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker