Healthcare Provider Details

I. General information

NPI: 1689598088
Provider Name (Legal Business Name): HALLE BROOKE WILSON LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 COULTER CT
PENDLETON SC
29670-9632
US

IV. Provider business mailing address

232 COULTER CT
PENDLETON SC
29670-9632
US

V. Phone/Fax

Practice location:
  • Phone: 704-458-2606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11020
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: