Provider Demographics
NPI:1861989527
Name:TALBERT, WENDY GALE (MED LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:GALE
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 POND OAK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2805
Mailing Address - Country:US
Mailing Address - Phone:803-530-9263
Mailing Address - Fax:
Practice Address - Street 1:900 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5816
Practice Address - Country:US
Practice Address - Phone:803-731-4708
Practice Address - Fax:803-612-1206
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional