MEDICARE: KATELYN SUE LABRIE LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10362	SC

General Provider Information

NPI Number	:	1518754431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN SUE LABRIE LPCA

Provider Business Mailing Address
First Line	:	PO BOX 1174
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-1174
Country	:	US
Telephone Number	:	803-638-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4486
Country	:	US
Telephone Number	:	803-638-4688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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