Individual
WILLIBA BROGDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
730 BROAD ST, C, SUMTER, SC 29150-3356
(704) 701-0836
Mailing address
730 BROAD ST, C, SUMTER, SC 29150-3356
(704) 701-0836
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000-000-0000
TARGETED CASE MANAGEMENT SERVICES
SC
Enumeration date
09/02/2015
Last updated
09/02/2015
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