Organization Name: | BRADFORD ASSOCIATES NC LLC |
NPI Number: | 1114268844 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BEATRICE ELLISON (MEMBER) |
Mailing Address: | 103 Bradford Village Ct Southern Pines |
State: | NC US |
Postal Code: | 283875451 |
Phone Number: | 9106922947 |
Fax Number: | |
NPI Enumeration Date: | 03/05/2013 |
NPI Last Update Date: | 04/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5580 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |