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General NPI Number Information
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NPI Number | 1053127431
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Entity Type | Individual
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Provider Name | TAYLOR BROOKE DEBERRY LPC-A
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Gender | Female
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1920 2ND LOOP RD
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City | FLORENCE
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State | SC
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Zip | 29501-6123
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Country | US
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Telephone | 843-629-0236
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 CLARENDON AVE
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City | FLORENCE
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State | SC
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Zip | 29505-3021
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Country | US
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Telephone | 843-610-1125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8490
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License Number State | SC
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