Provider Demographics
NPI:1063147148
Name:WOLTERS, ALLISON GRONER (LPC-A)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:GRONER
Last Name:WOLTERS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WINSTONS CHASE CT
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-8761
Mailing Address - Country:US
Mailing Address - Phone:803-493-8546
Mailing Address - Fax:
Practice Address - Street 1:702 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3121
Practice Address - Country:US
Practice Address - Phone:803-493-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional