Healthcare Provider Details

I. General information

NPI: 1538817317
Provider Name (Legal Business Name): DEVON BROOKE WERNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 PLAYGROUND RD
CHARLESTON SC
29407-6465
US

IV. Provider business mailing address

4994 OHEAR AVE APT 10303
NORTH CHARLESTON SC
29405-5044
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-2111
  • Fax:
Mailing address:
  • Phone: 401-644-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12582088
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: