Provider Demographics
NPI:1659007250
Name:LEO, BRANDY DAWN (LMSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DAWN
Last Name:LEO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BOSTICK CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5707
Mailing Address - Country:US
Mailing Address - Phone:904-322-2773
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG UNIT C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker