Provider Demographics
NPI:1194198671
Name:BROCKELMAN, KARIN (PHD, CRC, LPC)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:BROCKELMAN
Suffix:
Gender:F
Credentials:PHD, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 CALHOUN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2650
Mailing Address - Country:US
Mailing Address - Phone:803-936-2461
Mailing Address - Fax:
Practice Address - Street 1:1898 CALHOUN ST STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2650
Practice Address - Country:US
Practice Address - Phone:803-936-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6244101Y00000X
SC6944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor