Individual
KAITLIN WALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
222 PORT TACK DR, CHARLESTON, SC 29492-8933
(215) 932-4887
Mailing address
222 PORT TACK DR, CHARLESTON, SC 29492-8933
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PC015886
PA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/22/2021
Last updated
09/06/2023
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