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NPI Code Detail

MEDICARE: ANDREA BULLOCK BRADLEY ED.S., LPC

MEDICARE: ANDREA BULLOCK BRADLEY ED.S., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor5277SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952551426
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA BULLOCK BRADLEY ED.S., LPC
Provider Business Mailing Address
First Line : 4500 FORT JACKSON BLVD STE 110
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1134
Country : US
Telephone Number : 803-216-1107
Fax Number :
Provider Business Practice Location Address
First Line : 4500 FORT JACKSON BLVD STE 110
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1134
Country : US
Telephone Number : 803-216-1107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2008
Last Update Date : 09/23/2021

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