Provider Demographics
NPI:1598121204
Name:DEBORAH BRUNNER
Entity Type:Organization
Organization Name:DEBORAH BRUNNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-501-1099
Mailing Address - Street 1:1060 CLIFFWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3687
Mailing Address - Country:US
Mailing Address - Phone:843-501-1099
Mailing Address - Fax:843-405-2040
Practice Address - Street 1:1060 CLIFFWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3687
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:843-405-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty