Provider Demographics
NPI:1790567758
Name:PENDERGAST, BRANDIE (LPCMH, NCC)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:PENDERGAST
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 S TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5134
Mailing Address - Country:US
Mailing Address - Phone:302-538-1517
Mailing Address - Fax:
Practice Address - Street 1:1788 S TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5134
Practice Address - Country:US
Practice Address - Phone:302-538-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health