Healthcare Provider Details

I. General information

NPI: 1003704909
Provider Name (Legal Business Name): GABRIELLE BEDELL LCP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 STATE PARK RD
TRAVELERS REST SC
29690-1831
US

IV. Provider business mailing address

6715 STATE PARK RD
TRAVELERS REST SC
29690-1831
US

V. Phone/Fax

Practice location:
  • Phone: 864-774-4369
  • Fax:
Mailing address:
  • Phone: 864-774-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8437
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: