Individual provider · NPI-1

Brooke Burkholder

Counselor, Professional · Georgetown, SC

NPI number1821596719
StatusActive
Last updated in NPPESApr 25, 2024

Details

NPI
1821596719
Entity type
Individual (NPI-1)
Name
Brooke Burkholder
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 25, 2018
Certification date
Apr 25, 2024
Last updated
Apr 25, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YP2500X Counselor, Professional8842SCYes
101YM0800X Counselor, Mental HealthIMH12078FL
101YP1600X Counselor, Pastoral––
101YS0200X Counselor, School–FL

Practice location

103 Queen St Ste D&E
Georgetown, SC 29440-3633

Phone 843-849-4029

Mailing address

103 Queen St Ste E
Georgetown, SC 29440-3633

Phone 843-849-4029

Other practice locations

8807 Scandinavia Blvd
Lakeland, FL 33809-1745

Phone 863-398-8021

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