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General NPI Number Information
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NPI Number | 1821596719
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Entity Type | Individual
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Provider Name | BROOKE BURKHOLDER
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Gender | Female
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 103 QUEEN ST STE D&E
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City | GEORGETOWN
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State | SC
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Zip | 29440-3633
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Country | US
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Telephone | 843-849-4029
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Fax |
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Provider Business Mailing Address
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Address Line | 103 QUEEN ST STE E
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City | GEORGETOWN
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State | SC
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Zip | 29440-3633
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Country | US
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Telephone | 843-849-4029
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH12078
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8842
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License Number State | SC
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