Healthcare Provider Details

I. General information

NPI: 1750765517
Provider Name (Legal Business Name): WENDE B CONRAD M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLEVELAND ST STE 100
GREENVILLE SC
29601-4710
US

IV. Provider business mailing address

312 WATER MILL RD
GREER SC
29650-3627
US

V. Phone/Fax

Practice location:
  • Phone: 864-660-9407
  • Fax:
Mailing address:
  • Phone: 864-517-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2666
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: