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General NPI Number Information
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NPI Number | 1033557020
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Entity Type | Individual
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Provider Name | ANITA CARMEN BRADFORD LADAC
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Gender | Female
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 2960B AUSTIN PEAY HWY
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City | MEMPHIS
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State | TN
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Zip | 38128-5602
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Country | US
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Telephone | 901-372-7878
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 281601
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City | MEMPHIS
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State | TN
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Zip | 38168-0005
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Country | US
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Telephone | 901-372-7878
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Fax | 901-373-9298
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LDC0000000688
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License Number State | TN
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