Healthcare Provider Details

I. General information

NPI: 1184259228
Provider Name (Legal Business Name): WANDA KIRKLAND LPCA, CS, AADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 STATE FARM RD
REMBERT SC
29128-8219
US

IV. Provider business mailing address

713 FLINT LOCK CV
FLORENCE SC
29501-8056
US

V. Phone/Fax

Practice location:
  • Phone: 803-529-8276
  • Fax:
Mailing address:
  • Phone: 843-229-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10779
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: