Provider Demographics
NPI:1225473291
Name:BRADLEY, VIRLEE
Entity Type:Individual
Prefix:MRS
First Name:VIRLEE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 SEABOARD RD
Mailing Address - Street 2:
Mailing Address - City:SALTERS
Mailing Address - State:SC
Mailing Address - Zip Code:29590-3365
Mailing Address - Country:US
Mailing Address - Phone:843-387-5425
Mailing Address - Fax:843-387-5444
Practice Address - Street 1:500 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3408
Practice Address - Country:US
Practice Address - Phone:843-355-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor