Healthcare Provider Details

I. General information

NPI: 1306908306
Provider Name (Legal Business Name): WENNDY NICOLE DUPKOSKI LPC-S, LPC, NCC, PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENNDY DUPKOSKI MALLICOAT MS, LPC, NCC

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date: 02/06/2022
Reactivation Date: 03/24/2022

III. Provider practice location address

114 N CHURCH ST
LEXINGTON SC
29072-2808
US

IV. Provider business mailing address

114 N CHURCH ST
LEXINGTON SC
29072-2808
US

V. Phone/Fax

Practice location:
  • Phone: 803-210-7422
  • Fax:
Mailing address:
  • Phone: 803-210-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5178
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number#5165
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5165
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5178
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#5165
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: