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SHADISHA K BENNETT BRODDE LPC
Professional >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1477826022
Individual Registrant: SHADISHA K BENNETT BRODDE LPC
Gender: F
Not Sole Proprietor
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: --
Tel: 478-387-5582 Fax: --
Contact information for business:
910 GOLDEN LAKE LOOP SAINT AUGUSTINE, FL 32084-5877 US
Tel: 478-387-5582 Fax: --
Tel: 478-387-5582 Fax: --
Registration Information:
NPI: 1477826022
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YP2500X | Behavioral Health & Social Service Providers Counselor Professional | IL | 178005880 |
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor | FL | MH18303 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
