Provider Demographics
NPI:1972744761
Name:DEAN, BROOKE ASHLEY (PH D)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ASHLEY
Last Name:DEAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2118
Mailing Address - Country:US
Mailing Address - Phone:843-525-9255
Mailing Address - Fax:843-986-0744
Practice Address - Street 1:1203 PARIS AVE
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2118
Practice Address - Country:US
Practice Address - Phone:843-525-9255
Practice Address - Fax:843-986-0744
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical