Healthcare Provider Details

I. General information

NPI: 1639472939
Provider Name (Legal Business Name): BRADENTON COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 MANATEE AVE W STE 210
BRADENTON FL
34205-4954
US

IV. Provider business mailing address

2424 MANATEE AVE W STE 210
BRADENTON FL
34205-4954
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-0802
  • Fax: 941-795-2102
Mailing address:
  • Phone: 941-792-0802
  • Fax: 941-795-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2098
License Number StateFL

VIII. Authorized Official

Name: KRISTIE VIRGINIA COCHRAN
Title or Position: OWNER
Credential: LMHC
Phone: 941-792-0802