MEDICARE: NICOLE BROKA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	7957	SC

General Provider Information

NPI Number	:	1922718352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BROKA SMITH

Provider Business Mailing Address
First Line	:	22 PARLIAMENT RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3441
Country	:	US
Telephone Number	:	770-715-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 CLEVELAND ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2409
Country	:	US
Telephone Number	:	770-715-8184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “ NICOLE BROKA SMITH ” Practice Location

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