Individual
DONYA DEMESHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
201 SHORT ST, KINGSTREE, SC 29556-3926
(842) 354-7324
(843) 354-6461
Mailing address
992 JASMINE LN, FLORENCE, SC 29501-8599
(843) 773-9649
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4697
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WP8972
—
SC
Enumeration date
07/25/2006
Last updated
07/09/2007
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