Healthcare Provider Details

I. General information

NPI: 1417553876
Provider Name (Legal Business Name): BRANDI ELAINE VONBARTHELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 KIRKLAND DR
CONWAY SC
29526-2942
US

IV. Provider business mailing address

2213 KIRKLAND DR
CONWAY SC
29526-2942
US

V. Phone/Fax

Practice location:
  • Phone: 910-448-4547
  • Fax:
Mailing address:
  • Phone: 854-252-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: