Healthcare Provider Details

I. General information

NPI: 1285285205
Provider Name (Legal Business Name): KERI BROOME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PALMETTO PARK BLVD
LEXINGTON SC
29072-7872
US

IV. Provider business mailing address

251 SHILOH CT
BATESBURG SC
29006-8943
US

V. Phone/Fax

Practice location:
  • Phone: 803-996-1500
  • Fax:
Mailing address:
  • Phone: 803-640-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9181
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: