Provider Demographics
NPI:1154658854
Name:KINDER, BRADLEY TODD (LPC, CSAC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:TODD
Last Name:KINDER
Suffix:
Gender:M
Credentials:LPC, CSAC
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 426
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0426
Mailing Address - Country:US
Mailing Address - Phone:276-963-0111
Mailing Address - Fax:276-963-0005
Practice Address - Street 1:1100 CEDAR VALLEY DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-963-0111
Practice Address - Fax:276-963-0005
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional