Provider Demographics
NPI:1467803858
Name:ANDREGIC, BROOKE (LISW-CP, RPT)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:ANDREGIC
Suffix:
Gender:F
Credentials:LISW-CP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-8815
Mailing Address - Country:US
Mailing Address - Phone:864-810-4496
Mailing Address - Fax:
Practice Address - Street 1:527 CAMPGROUND RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-8815
Practice Address - Country:US
Practice Address - Phone:864-810-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11728OtherSC LICENSE