Healthcare Provider Details

I. General information

NPI: 1700707882
Provider Name (Legal Business Name): BRAYDIEN CANTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SHIRLEY ST
CALHOUN FALLS SC
29628-1342
US

IV. Provider business mailing address

705 SHIRLEY ST
CALHOUN FALLS SC
29628-1342
US

V. Phone/Fax

Practice location:
  • Phone: 864-617-9476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1615991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: