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General NPI Number Information
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NPI Number | 1053820050
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Entity Type | Individual
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Provider Name | ANDREA BRAGDON M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 555 MOULTRIE LANDING BLVD APT 6106
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5984
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Country | US
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Telephone | 207-844-0503
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH18130
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC6599
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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