Provider Demographics
NPI:1235507054
Name:BRABHAM, CIERRA (LPCI)
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ROSS RD APT 6I
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4915
Mailing Address - Country:US
Mailing Address - Phone:803-269-0824
Mailing Address - Fax:
Practice Address - Street 1:5307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6113
Practice Address - Country:US
Practice Address - Phone:803-269-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health