Provider Demographics
NPI:1144568551
Name:SPERDUTO, BROOKE BUCHOLTZ (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:BUCHOLTZ
Last Name:SPERDUTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:BUCHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:250 MATHIS FERRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2988
Mailing Address - Country:US
Mailing Address - Phone:843-571-9171
Mailing Address - Fax:843-971-5178
Practice Address - Street 1:250 MATHIS FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2988
Practice Address - Country:US
Practice Address - Phone:843-571-9171
Practice Address - Fax:843-971-5178
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 5457101YP2500X
GALPC006911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional