Individual
CAMILLA KATHLYNE BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCS
Contact information
Practice address
250 MILL ST, SUITE PW2213, TAYLORS, SC 29687-2465
(864) 320-1648
Mailing address
250 MILL ST, SUITE PW2213, TAYLORS, SC 29687-2465
(864) 320-1648
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3829
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
10/03/2013
Last updated
04/06/2017
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