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General NPI Number Information
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NPI Number | 1841070950
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Entity Type | Individual
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Provider Name | BRADLEY CRAIG SHORTT LPC
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Gender | Male
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 261 NORTH ST
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City | BRISTOL
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State | VA
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Zip | 24201-3275
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Country | US
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Telephone | 276-807-8070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 352
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City | ABINGDON
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State | VA
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Zip | 24212-0352
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Country | US
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Telephone | 276-393-1201
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701012931
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License Number State | VA
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