Provider Demographics
NPI:1457027021
Name:SHEPHERD, BRANDI NIKKOLE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NIKKOLE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 OAKDALE TERRACE BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8586
Mailing Address - Country:US
Mailing Address - Phone:803-466-6093
Mailing Address - Fax:
Practice Address - Street 1:510 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4396
Practice Address - Country:US
Practice Address - Phone:843-332-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)