Healthcare Provider Details

I. General information

NPI: 1922943950
Provider Name (Legal Business Name): LEIGH-ANNE JANENE BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 OSIGIAN BLVD STE 400
WARNER ROBINS GA
31088-8992
US

IV. Provider business mailing address

107 JIM ARYARD SMITH CIR
LYONS GA
30436-7751
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-3058
  • Fax:
Mailing address:
  • Phone: 912-388-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: