Provider Demographics
NPI:1114065208
Name:BRAND, DENISE R (LPC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:BRAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CHAMBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5428
Mailing Address - Country:US
Mailing Address - Phone:843-655-1622
Mailing Address - Fax:843-650-4890
Practice Address - Street 1:9403 HIGHWAY 707 STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7758
Practice Address - Country:US
Practice Address - Phone:843-655-1622
Practice Address - Fax:843-650-4890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional