Provider Demographics
NPI:1033557020
Name:BRADFORD, ANITA CARMEN (LADAC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:CARMEN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LADAC
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 281601
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38168-0005
Mailing Address - Country:US
Mailing Address - Phone:901-372-7878
Mailing Address - Fax:901-373-9298
Practice Address - Street 1:2960B AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5602
Practice Address - Country:US
Practice Address - Phone:901-372-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000688101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)