Provider Demographics
NPI:1225076789
Name:BLAYDES, KATHY J (LPC; CCMHC; NCC; MAC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:BLAYDES
Suffix:
Gender:F
Credentials:LPC; CCMHC; NCC; MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LADYS ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1643
Mailing Address - Country:US
Mailing Address - Phone:843-986-0046
Mailing Address - Fax:843-986-0046
Practice Address - Street 1:80 LADYS ISLAND DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1643
Practice Address - Country:US
Practice Address - Phone:843-986-0046
Practice Address - Fax:843-986-0046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional