Bennett Brodde, Shadisha K

Bennett Brodde, Shadisha K is an individual health care provider with primary practice located at 910 Golden Lake Loop , Saint Augustine FL 32084-5877. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Bennett Brodde, Shadisha K can be contacted via phone (478) 387-5582.

Contact Information

Primary practice address
910 Golden Lake Loop Saint Augustine FL 32084-5877
Phone: (478) 387-5582
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 178005880 Illinois
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH18303 Florida

Profile Details

NPI number 1477826022
LBN Legal business name Bennett Brodde, Shadisha K
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2012
Last updated Jun 16th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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