Healthcare Provider Details

I. General information

NPI: 1184025546
Provider Name (Legal Business Name): TERRENCE WYATT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 HUMAN SERVICES RD
CLINTON SC
29325-7548
US

IV. Provider business mailing address

219 HUMAN SERVICES RD
CLINTON SC
29325-7548
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7836
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: