Healthcare Provider Details

I. General information

NPI: 1023461589
Provider Name (Legal Business Name): BERTHA YVETTE MYERS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BERTHA YVETTE BROOKINS MA

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 CLEMSON RD UNIT 292241
COLUMBIA SC
29229-0590
US

IV. Provider business mailing address

1805 CLEMSON RD UNIT 292241
COLUMBIA SC
29229-0590
US

V. Phone/Fax

Practice location:
  • Phone: 803-361-6004
  • Fax: 803-753-9552
Mailing address:
  • Phone: 803-361-6004
  • Fax: 803-753-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7290
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: