Individual
BENJAMIN MATTHEW WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2113 ADAMS GRV STE 110, COLUMBIA, SC 29203-6957
(803) 206-5948
Mailing address
1118 BENTON ST, COLUMBIA, SC 29201-1816
(803) 206-5948
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
11128
SC
Other
Enumeration date
07/21/2025
Last updated
07/21/2025
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