Healthcare Provider Details

I. General information

NPI: 1457780074
Provider Name (Legal Business Name): ROSALYN SHERRY SYPHRETT BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 HIGHWAY 521 BYP S
LANCASTER SC
29720-7579
US

IV. Provider business mailing address

1906 HWY 521 BYPASS SOUTH
LANCASTER SC
29720
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-7456
  • Fax: 803-285-5514
Mailing address:
  • Phone: 803-285-7456
  • Fax: 803-285-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: