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General NPI Number Information
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NPI Number | 1962110056
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Entity Type | Individual
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Provider Name | GLEN ROBERT HARDBECK BRADLEY MA, LGPC (DC)
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Gender | Male
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 2333 ONTARIO RD NW
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City | WASHINGTON
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State | DC
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Zip | 20009-2627
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Country | US
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Telephone | 202-483-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 7TH ST NW # 230
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City | WASHINGTON
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State | DC
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Zip | 20001-3107
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Country | US
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Telephone | 816-286-6555
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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 | LGPC200001455
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License Number State | DC
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