Healthcare Provider Details

I. General information

NPI: 1730027897
Provider Name (Legal Business Name): BROOKE COLVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S ELM ST
PENDLETON SC
29670-1943
US

IV. Provider business mailing address

315 S ELM ST
PENDLETON SC
29670-1943
US

V. Phone/Fax

Practice location:
  • Phone: 864-622-9392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: