Provider Demographics
NPI:1063729945
Name:WYMER, BROOKE CHARLENE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:CHARLENE
Last Name:WYMER
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 1:1615 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5629
Mailing Address - Country:US
Mailing Address - Phone:803-791-1511
Mailing Address - Fax:803-791-1572
Practice Address - Street 1:1615 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5629
Practice Address - Country:US
Practice Address - Phone:803-791-1511
Practice Address - Fax:803-791-1572
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9547104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker