Healthcare Provider Details

I. General information

NPI: 1013051580
Provider Name (Legal Business Name): CAMILLE HUTCHINS BROOM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DOVER CT
ANDERSON SC
29625-2558
US

IV. Provider business mailing address

420 DOVER CT
ANDERSON SC
29625-2558
US

V. Phone/Fax

Practice location:
  • Phone: 864-401-1665
  • Fax:
Mailing address:
  • Phone: 864-401-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4781
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: