Provider Demographics
NPI:1427473115
Name:SPURRIER, BRANTLEE JACKSON (MSW, LISWCP)
Entity type:Individual
Prefix:
First Name:BRANTLEE
Middle Name:JACKSON
Last Name:SPURRIER
Suffix:
Gender:F
Credentials:MSW, LISWCP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:BRANTLEE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-1627
Mailing Address - Country:US
Mailing Address - Phone:803-810-8749
Mailing Address - Fax:
Practice Address - Street 1:300 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1627
Practice Address - Country:US
Practice Address - Phone:803-810-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041S0200X
SC103471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool