Provider Demographics
NPI:1649745845
Name:DENNIS, BRANDI T (LPES)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:T
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 2ND LOOP RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6187
Mailing Address - Country:US
Mailing Address - Phone:843-468-1850
Mailing Address - Fax:
Practice Address - Street 1:2011 2ND LOOP RD STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6187
Practice Address - Country:US
Practice Address - Phone:843-468-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4626103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4626OtherLICENSE NUMBER