Panora Zenik Wallace-Jackson, MA, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

576 W Carolina Ave
Hartsville, SC 29550-5412

Phone

(843) 309-9340

Fax

(843) 309-9341

NPI assigned

Nov 8, 2007

Last updated

Mar 12, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Panora Zenik Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1336329291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 W CAROLINA AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295505412",
            "telephone_number": "843-309-9340",
            "fax_number": "843-309-9341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 W CAROLINA AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295505412",
            "telephone_number": "843-309-9340",
            "fax_number": "843-309-9341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-JACKSON",
        "first_name": "PANORA",
        "middle_name": "ZENIK",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-08",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PANORA",
            "last_name": "WALLACE",
            "middle_name": "ZENIK",
            "prefix": "MS.",
            "credential": "M.A.,LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Counselor in Hartsville, SC
• Providers in Hartsville, SC by specialty
• Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.