Provider Demographics
NPI:1619702818
Name:BRUCKS, BELINDA ROSE (MA, LMFTA)
Entity type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:ROSE
Last Name:BRUCKS
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7701
Mailing Address - Country:US
Mailing Address - Phone:210-789-7132
Mailing Address - Fax:
Practice Address - Street 1:5 CLUSTERS CT STE 106
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4831
Practice Address - Country:US
Practice Address - Phone:803-380-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist