| Doctor Name: | BRADLEY D BURGESS |
| NPI Number: | 1730480971 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A.. |
| License Number: | |
| Business Practice Address: | 737 S Main St Society Hill, SC - 295938972 |
| Business Phone Number: | 8433784501 |
| Business Fax Number: | 8433784209 |
| Mailing Address: | Po Box 1090, HARTSVILLE |
| State: | SC |
| Postal Code: | 295511090 |
| Phone Number: | 8438570111 |
| Fax Number: | 8438570206 |
| NPI Enumeration Date: | 11/04/2010 |
| NPI Last Update Date: | 09/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |