Provider Demographics
NPI:1750765517
Name:CONRAD, WENDE B (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:WENDE
Middle Name:B
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WATER MILL RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3627
Mailing Address - Country:US
Mailing Address - Phone:864-517-0604
Mailing Address - Fax:
Practice Address - Street 1:1 CLEVELAND ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4710
Practice Address - Country:US
Practice Address - Phone:864-660-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2666101YP2500X
NC1787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical