MEDICARE: CIERRA LATREECE BRABHAM LPC, LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6032	SC

General Provider Information

NPI Number	:	1235507054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA LATREECE BRABHAM LPC, LCMHC

Provider Business Mailing Address
First Line	:	310 ROSS RD APT 6I
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4915
Country	:	US
Telephone Number	:	803-269-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 FIREBRIDGE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5101
Country	:	US
Telephone Number	:	803-269-0824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	10/29/2024

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