Provider Demographics
NPI:1659888048
Name:DAVIS, BROOKE BECKWITH (LISW-CP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BECKWITH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:BROOKE
Other - Last Name:BECKWITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:920 HOUNDSLAKE DR # B204
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5924
Mailing Address - Country:US
Mailing Address - Phone:803-816-1260
Mailing Address - Fax:
Practice Address - Street 1:920 HOUNDSLAKE DR # B204
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5924
Practice Address - Country:US
Practice Address - Phone:803-816-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical