Healthcare Provider Details

I. General information

NPI: 1447863196
Provider Name (Legal Business Name): DR. BRENDA PATTERSON ISHMAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 NEESES CAMP RD
NEESES SC
29107-9428
US

IV. Provider business mailing address

232 NEESES CAMP RD
NEESES SC
29107-9428
US

V. Phone/Fax

Practice location:
  • Phone: 704-661-4705
  • Fax:
Mailing address:
  • Phone: 704-661-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1117935
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1117935
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: