Provider Demographics
NPI:1114268844
Name:BRADFORD ASSOCIATES NC LLC
Entity Type:Organization
Organization Name:BRADFORD ASSOCIATES NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-692-2947
Mailing Address - Street 1:103 BRADFORD VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5451
Mailing Address - Country:US
Mailing Address - Phone:910-692-2947
Mailing Address - Fax:
Practice Address - Street 1:103 BRADFORD VILLAGE CT
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5451
Practice Address - Country:US
Practice Address - Phone:910-692-2947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty