Provider Demographics
NPI:1912341694
Name:JAMES, WANDA L (MA)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:JAMES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 7632
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7632
Mailing Address - Country:US
Mailing Address - Phone:843-473-7242
Mailing Address - Fax:843-773-6216
Practice Address - Street 1:181 E. EVANS ST #14-B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2511
Practice Address - Country:US
Practice Address - Phone:843-473-7242
Practice Address - Fax:843-773-6216
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5408101YP2500X
SC6393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional