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General NPI Number Information
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NPI Number | 1164922829
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Entity Type | Individual
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Provider Name | JESSICA NICOLE BRADHAM LPA
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Gender | Female
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 7406 CHAPEL HILL RD STE GH
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City | RALEIGH
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State | NC
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Zip | 27607-5077
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Country | US
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Telephone | 919-346-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 129 OLIVEPARK DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6224
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Country | US
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Telephone | 513-407-2442
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 5032
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License Number State | NC
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