Active NPI
Landon Wallace
- Mental Health Counselor
- Lexington, SC
National Provider Identifier
1174108682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8287
- Practice address
- 305 Palmetto Park Blvd
Lexington, SC 29072-7872 - Phone
- (803) 996-1500
- NPI assigned
- Mar 16, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8287 | SC | Primary |
Addresses
Primary practice location
305 Palmetto Park Blvd
Lexington, SC 29072-7872
Mailing address
108 Palmetto Park Blvd
Lexington, SC 29072-7968
Phone (803) 996-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8287 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695168000000",
"number": "1174108682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 PALMETTO PARK BLVD",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290727968",
"telephone_number": "803-996-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 PALMETTO PARK BLVD",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290727872",
"telephone_number": "803-996-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LANDON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-03-16",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "SC",
"license": "8287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.