Healthcare Provider Details

I. General information

NPI: 1447356985
Provider Name (Legal Business Name): HOLLY G BRUHN LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E MAIN ST
MONCKS CORNER SC
29461-3764
US

IV. Provider business mailing address

117 E MAIN ST
MONCKS CORNER SC
29461-3764
US

V. Phone/Fax

Practice location:
  • Phone: 843-899-4949
  • Fax: 843-899-7224
Mailing address:
  • Phone: 843-899-4949
  • Fax: 843-899-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6681
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: