Provider Demographics
NPI:1003944489
Name:BRADLEY, DAVID M (MA, MDIV)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8542
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28814-8542
Mailing Address - Country:US
Mailing Address - Phone:828-989-8301
Mailing Address - Fax:
Practice Address - Street 1:789 MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2447
Practice Address - Country:US
Practice Address - Phone:828-989-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist