Provider Demographics
NPI:1538339890
Name:CORDER, BRANDY NICOLE (LPCC, LCADC)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:NICOLE
Last Name:CORDER
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:CORDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:664 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-9125
Mailing Address - Country:US
Mailing Address - Phone:606-765-0811
Mailing Address - Fax:
Practice Address - Street 1:664 PERKINS RD
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-9125
Practice Address - Country:US
Practice Address - Phone:606-765-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103671101YM0800X
KY1194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health