Healthcare Provider Details

I. General information

NPI: 1962325605
Provider Name (Legal Business Name): YVONNE BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SPIERS LANDING RD
CROSS SC
29436-3422
US

IV. Provider business mailing address

1330 SPIERS LANDING RD
CROSS SC
29436-3422
US

V. Phone/Fax

Practice location:
  • Phone: 843-753-3150
  • Fax: 843-753-2261
Mailing address:
  • Phone: 843-753-3150
  • Fax: 843-753-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: