Provider Demographics
NPI:1306908306
Name:DUPKOSKI, WENNDY NICOLE (LPC-S, LPC, NCC, PH)
Entity type:Individual
Prefix:DR
First Name:WENNDY
Middle Name:NICOLE
Last Name:DUPKOSKI
Suffix:
Gender:F
Credentials:LPC-S, LPC, NCC, PH
Other - Prefix:DR
Other - First Name:WENNDY
Other - Middle Name:DUPKOSKI
Other - Last Name:MALLICOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:114 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2808
Mailing Address - Country:US
Mailing Address - Phone:803-210-7422
Mailing Address - Fax:
Practice Address - Street 1:114 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2808
Practice Address - Country:US
Practice Address - Phone:803-210-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2022-03-24
Deactivation Date:2022-02-06
Deactivation Code:
Reactivation Date:2022-03-24
Provider Licenses
StateLicense IDTaxonomies
NC5165101YM0800X
SC5178101YP2500X, 101Y00000X
NC#5165101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103176Medicaid