Individual
MS. JACQUELINE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
1016 SILO LN, ANDERSON, SC 29625-6753
(864) 314-5707
Mailing address
1016 SILO LN, ANDERSON, SC 29625-6753
(864) 314-5707
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5250
SC
Other
Enumeration date
05/14/2013
Last updated
05/14/2013
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