Provider Demographics
NPI:1730201815
Name:NUNN, WANDA (LPC)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:NUNN
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 1:742 CINDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-479-1027
Mailing Address - Fax:866-344-1607
Practice Address - Street 1:2611 FOREST DR
Practice Address - Street 2:SUITE 129
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-251-0104
Practice Address - Fax:866-344-1607
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional