Individual
LANDON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 PALMETTO PARK BLVD, LEXINGTON, SC 29072-7872
(803) 996-1500
Mailing address
108 PALMETTO PARK BLVD, LEXINGTON, SC 29072-7968
(803) 996-1500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8287
SC
Other
Enumeration date
03/16/2021
Last updated
09/20/2023
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