Provider Demographics
NPI:1235446014
Name:BRADFORD-HEIDORN, ANGELA KAY (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:BRADFORD-HEIDORN
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BAYARD PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-463-2910
Mailing Address - Fax:812-463-2760
Practice Address - Street 1:4601 BAYARD PARK DRIVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-463-2910
Practice Address - Fax:812-463-2760
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000301A101YA0400X
IN34005632A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)