Provider Demographics
NPI:1174827216
Name:BROOKS, BIANCA M (LISW)
Entity Type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:M
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:20 POWDERHORN RD
Mailing Address - Street 2:SIMPSONVILLE
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3399
Mailing Address - Country:US
Mailing Address - Phone:864-963-3421
Mailing Address - Fax:
Practice Address - Street 1:20 POWDERHORN RD
Practice Address - Street 2:SIMPSONVILLE
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3399
Practice Address - Country:US
Practice Address - Phone:864-963-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054363001041C0700X
SC119481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical