Provider Demographics
NPI:1194199885
Name:BRADFORD, ANNE B (LPC, NCC, CAMS)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:B
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LPC, NCC, CAMS
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 1329
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-1329
Mailing Address - Country:US
Mailing Address - Phone:478-254-0677
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE POINTE STE 112
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3439
Practice Address - Country:US
Practice Address - Phone:478-254-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011065101YP2500X
GAAPC 005500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional