Healthcare Provider Details

I. General information

NPI: 1326606526
Provider Name (Legal Business Name): AARON JOESEPH BRADLEY LICDC.162763
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

IV. Provider business mailing address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

V. Phone/Fax

Practice location:
  • Phone: 740-961-1828
  • Fax:
Mailing address:
  • Phone: 740-901-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162763
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406656
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: