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General NPI Number Information
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NPI Number | 1407330319
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Entity Type | Individual
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Provider Name | MAMIE ARNETTA BRADSHAW CDCA
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 3131 HARVEY AVE STE 104
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City | CINCINNATI
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State | OH
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Zip | 45229-3006
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Country | US
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Telephone | 513-585-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 450 GRAND AVE UNIT 1
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City | CINCINNATI
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State | OH
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Zip | 45205-2259
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Country | US
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Telephone | 513-307-3501
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.161803
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License Number State | OH
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