| Doctor Name: | DIANE K. BRADSHAW |
| NPI Number: | 1396912986 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | 7216 |
| Business Practice Address: | 367 Great Forest Rd Grimesland, NC - 278379049 |
| Business Phone Number: | 2529164613 |
| Business Fax Number: | 2523284868 |
| Mailing Address: | 367 Great Forest Rd, GRIMESLAND |
| State: | NC |
| Postal Code: | 278379049 |
| Phone Number: | 2529164613 |
| Fax Number: | 2523284868 |
| NPI Enumeration Date: | 05/13/2008 |
| NPI Last Update Date: | 07/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 7216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |