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General NPI Number Information
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NPI Number | 1972363208
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Entity Type | Individual
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Provider Name | MEKEISHA BRADLEY CEO, CMA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 6900 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6427
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Country | US
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Telephone | 919-926-9255
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Fax | 919-741-5865
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Provider Business Mailing Address
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Address Line | 6900 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6427
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Country | US
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Telephone | 919-900-7145
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Fax | 919-741-5865
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 27601
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1660
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License Number State | NC
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