Provider Demographics
NPI:1093805426
Name:MCBROOM, W. SCOTT (DMIN, LPC)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:SCOTT
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CASA BIANCA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-9608
Mailing Address - Country:US
Mailing Address - Phone:843-766-4004
Mailing Address - Fax:
Practice Address - Street 1:1293 ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3947
Practice Address - Country:US
Practice Address - Phone:843-766-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2459101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional