Individual
MISS JENNETTE ILENE BRUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605
(864) 455-4828
(864) 455-1710
Mailing address
701 GROVE RD, GREENVILLE, SC 29605-5611
(864) 455-4828
(864) 455-1710
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4906
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301100
—
SC
Enumeration date
09/02/2006
Last updated
02/29/2012
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