Provider Demographics
NPI:1982615308
Name:WIMBERLEY, LISA A (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WIMBERLEY
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 1:2346 DANIEL ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8132
Mailing Address - Country:US
Mailing Address - Phone:843-442-7689
Mailing Address - Fax:843-377-8929
Practice Address - Street 1:1954 ASHLEY RIVER RD
Practice Address - Street 2:SUITE H
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4904
Practice Address - Country:US
Practice Address - Phone:843-552-8177
Practice Address - Fax:843-571-2742
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional