Healthcare Provider Details

I. General information

NPI: 1245520444
Provider Name (Legal Business Name): VIRGINIA MAY LYNN BRADEN LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA MAY LYNN BRADEN LICDC

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S STATE ST
OSCODA MI
48750-1635
US

IV. Provider business mailing address

1035 W WASHINGTON AVE
ALPENA MI
49707-2929
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-2550
  • Fax: 989-358-3750
Mailing address:
  • Phone: 989-358-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151108
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-02859
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: