Provider Demographics
NPI:1447521984
Name:OSTERHOUDT, BROOKE HEATHER (MSW, LCSW, LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:HEATHER
Last Name:OSTERHOUDT
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:HEATHER
Other - Last Name:MCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, LISW-CP
Mailing Address - Street 1:16 HAMILTONS FERRY RD
Mailing Address - Street 2:C/O SHANA LOTT
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8911
Mailing Address - Country:US
Mailing Address - Phone:303-588-0316
Mailing Address - Fax:
Practice Address - Street 1:1714 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4459
Practice Address - Country:US
Practice Address - Phone:704-413-4891
Practice Address - Fax:704-228-7369
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0113881041C0700X
CO6884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)