Healthcare Provider Details

I. General information

NPI: 1609762814
Provider Name (Legal Business Name): ISABELLE MANDELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MAPLE ST
COLUMBIA SC
29205-1629
US

IV. Provider business mailing address

920 MAPLE ST
COLUMBIA SC
29205-1629
US

V. Phone/Fax

Practice location:
  • Phone: 803-446-2295
  • Fax:
Mailing address:
  • Phone: 803-446-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number952
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: