Provider Demographics
NPI:1164034294
Name:BORDELON, ASHLYN BROOKE (M ED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLYN
Middle Name:BROOKE
Last Name:BORDELON
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SAINT ANDREWS RD STE D1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4488
Mailing Address - Country:US
Mailing Address - Phone:803-638-4688
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT ANDREWS RD STE D1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4488
Practice Address - Country:US
Practice Address - Phone:803-638-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7476101YM0800X
SC8397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty