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General NPI Number Information
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NPI Number | 1306498357
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Entity Type | Individual
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Provider Name | WAKITA DEMITRIUS BARKSDALE M.A.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 223 E MAIN ST STE 304
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City | ROCK HILL
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State | SC
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Zip | 29730-4571
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Country | US
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Telephone | 803-328-1625
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Fax | 803-328-1635
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Provider Business Mailing Address
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Address Line | 2908 TALLGRASS BLF
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City | ROCK HILL
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State | SC
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Zip | 29732-5528
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Country | US
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Telephone | 803-322-4042
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6675
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License Number State | SC
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