Provider Demographics
NPI:1235190653
Name:BRAWLEY, TORA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TORA
Middle Name:L
Last Name:BRAWLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-434-4300
Mailing Address - Fax:803-434-4277
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4277
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC752103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0311Medicaid
SCQ322544411Medicare PIN
Q322544411Medicare ID - Type Unspecified
SCPS0311Medicaid