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General NPI Number Information
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NPI Number | 1881275980
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Entity Type | Individual
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Provider Name | ASHLY NICOLE BRADLEY LPC
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 484 MADDOX RD
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City | GLADYS
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State | VA
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Zip | 24554-3030
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Country | US
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Telephone | 434-435-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 LITTLE BEAR LN
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City | SPOUT SPRING
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State | VA
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Zip | 24593-3013
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Country | US
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Telephone | 434-609-0386
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701010344
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License Number State | VA
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