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SHADISHA K BENNETT BRODDE LPC

Professional >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1477826022

Individual Registrant:
 SHADISHA K BENNETT BRODDE LPC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
910 GOLDEN LAKE LOOP  SAINT AUGUSTINE, FL 32084-5877 US
Tel: 478-387-5582  Fax: --

Contact information for business:
910 GOLDEN LAKE LOOP  SAINT AUGUSTINE, FL 32084-5877 US
Tel: 478-387-5582  Fax: --

Registration Information:
NPI: 1477826022
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YP2500XBehavioral Health & Social Service Providers
Counselor
Professional
IL178005880
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
FLMH18303

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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