Healthcare Provider Details

I. General information

NPI: 1124512066
Provider Name (Legal Business Name): BRADLEY WAYNE MILLER LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 N BRIGHTLEAF BLVD STE F
SMITHFIELD NC
27577-4876
US

IV. Provider business mailing address

PO BOX 1048
SELMA NC
27576-1048
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-1312
  • Fax:
Mailing address:
  • Phone: 919-903-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013400
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: