Healthcare Provider Details

I. General information

NPI: 1073304341
Provider Name (Legal Business Name): BRIDGET MARION BRADHAM LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GREENWAY ST NW STE 5
GLEN BURNIE MD
21061-3557
US

IV. Provider business mailing address

7671 QUARTERFIELD RD STE 301
GLEN BURNIE MD
21061-4525
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-9079
  • Fax: 410-760-1121
Mailing address:
  • Phone: 443-267-2097
  • Fax: 410-210-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP16317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: