Benjamin Matthew Waller, LPC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

11128 Issued in SC

Practice address

2113 Adams GRV Ste 110
Columbia, SC 29203-6957

Phone

(803) 206-5948

NPI assigned

Jul 21, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1740162940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 BENTON ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292011816",
            "telephone_number": "803-206-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 ADAMS GRV STE 110",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036957",
            "telephone_number": "803-206-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "BENJAMIN",
        "middle_name": "MATTHEW",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "SC",
            "license": "11128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latonia Wallace, CNA
• Ruth Adeline Wallace, RN, NC-BC
• Sallie C Wallace, ATC
• Seniya Wallace
• Mohammed Naim Wallam, MD
• Edward D Waller, PH.D.
• Elizabeth D Waller, MD
• Chadwick Glenn Walls
• Karen Craig Walpole, M.D.
• Cassandra Walsh, APRN

• Counseling Psychologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Counseling Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.