Provider Demographics
NPI:1447863196
Name:ISHMAEL, BRENDA PATTERSON
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:PATTERSON
Last Name:ISHMAEL
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 1:232 NEESES CAMP RD
Mailing Address - Street 2:
Mailing Address - City:NEESES
Mailing Address - State:SC
Mailing Address - Zip Code:29107-9428
Mailing Address - Country:US
Mailing Address - Phone:704-661-4705
Mailing Address - Fax:
Practice Address - Street 1:232 NEESES CAMP RD
Practice Address - Street 2:
Practice Address - City:NEESES
Practice Address - State:SC
Practice Address - Zip Code:29107-9428
Practice Address - Country:US
Practice Address - Phone:704-661-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
SC1117935101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor