Provider Demographics
NPI:1053127431
Name:DEBERRY, TAYLOR BROOKE (LPC-A)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:BROOKE
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3021
Mailing Address - Country:US
Mailing Address - Phone:843-610-1125
Mailing Address - Fax:
Practice Address - Street 1:1920 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6123
Practice Address - Country:US
Practice Address - Phone:843-629-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional