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General NPI Number Information
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NPI Number | 1740355288
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Entity Type | Individual
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Provider Name | BRADLEY HIEGER PH.D., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 5975 PARKWAY NORTH BLVD SUITE 300 D
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City | CUMMING
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State | GA
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Zip | 30040-1226
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Country | US
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Telephone | 404-388-3909
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Fax | 678-712-1945
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Provider Business Mailing Address
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Address Line | 5975 PARKWAY NORTH BLVD SUITE 300 D
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City | CUMMING
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State | GA
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Zip | 30040-1226
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Country | US
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Telephone | 404-388-3909
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Fax | 678-712-1945
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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 | LPC005028
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003603
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY003603
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License Number State | GA
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