Individual
LATASHA BROOMFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC, CACI
Contact information
Practice address
409 SIMPKINS ST, EDGEFIELD, SC 29824-1313
(803) 637-5788
Mailing address
409 SIMPKINS ST, EDGEFIELD, SC 29824-1313
(803) 637-5788
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6126
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
03/24/2014
Last updated
12/07/2016
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