Healthcare Provider Details

I. General information

NPI: 1639808512
Provider Name (Legal Business Name): ASHLEE NICOLE BREDAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 WOODRUFF RD PMB 3032 STE E
SIMPSONVILLE SC
29681
US

IV. Provider business mailing address

2607 WOODRUFF RD PMB 3032 STE E
SIMPSONVILLE SC
29681
US

V. Phone/Fax

Practice location:
  • Phone: 864-688-9279
  • Fax:
Mailing address:
  • Phone: 864-688-9279
  • Fax:

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: