Healthcare Provider Details

I. General information

NPI: 1700703923
Provider Name (Legal Business Name): TRACY RABIDEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 NE MAIN ST
SIMPSONVILLE SC
29681-2051
US

IV. Provider business mailing address

205 FARRS BRIDGE RD
GREENVILLE SC
29617-1905
US

V. Phone/Fax

Practice location:
  • Phone: 864-383-0384
  • Fax: 864-568-3938
Mailing address:
  • Phone: 864-383-0384
  • Fax: 864-568-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18981
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: