Healthcare Provider Details

I. General information

NPI: 1598676397
Provider Name (Legal Business Name): WREN BROOKE LMFT-A, MMFT
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ALYSSA WREN BROOKE LMFT-A, MMFT

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CAPEWOOD RD APT 259
SIMPSONVILLE SC
29680-2775
US

IV. Provider business mailing address

6650 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-4809
US

V. Phone/Fax

Practice location:
  • Phone: 864-800-3764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCOU.11204MFTI
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: