Kaitlin Wallick, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PC015886 Issued in PA

Practice address

222 Port Tack Dr
Charleston, SC 29492-8933

Phone

(215) 932-4887

NPI assigned

Jun 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1962071092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 PORT TACK DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294928933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 PORT TACK DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294928933",
            "telephone_number": "215-932-4887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1081 Oak St Unit 3",
            "address_purpose": "LOCATION",
            "city": "Pittston",
            "state": "PA",
            "postal_code": "186403716",
            "country_code": "US",
            "telephone_number": "888-726-4774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLICK",
        "first_name": "KAITLIN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC015886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Wallace, LMSW
• Micah Jordan Wallace, PHARM.D.
• Victoria Catherine Wallace
• Wilber Wallace
• Kaylie Waller
• Judy R Walling, FNP
• Elizabeth Mary Wallis, M.D.
• Amy Middleton Wallman, RPH
• Amanda Walsh, MD
• David J Walsh, MD

• Mental Health Counselor in Charleston, SC
• Providers in Charleston, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.

Verify at the official NPI Registry.