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General NPI Number Information
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NPI Number | 1851065072
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Entity Type | Organization
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Legal Business Name | JUSTINE F. BRADLEY, LPC, LLC
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 110 BRUNSWICK LN
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City | MARION
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State | VA
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Zip | 24354-3339
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Country | US
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Telephone | 276-285-5203
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Fax | 276-285-5455
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Provider Business Mailing Address
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Address Line | 110 BRUNSWICK LN
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City | MARION
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State | VA
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Zip | 24354-3339
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Country | US
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Telephone | 276-285-5203
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Fax | 276-285-5455
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | JUSTINE F BRADLEY
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Credential | LPC
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Telephone | 276-285-5203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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