Provider Demographics
NPI:1255000691
Name:PATRICK-BRADBERRY, BONNIE LEAH
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEAH
Last Name:PATRICK-BRADBERRY
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 1:208 KING ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4720
Mailing Address - Country:US
Mailing Address - Phone:803-432-6902
Mailing Address - Fax:
Practice Address - Street 1:208 KING ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4720
Practice Address - Country:US
Practice Address - Phone:803-432-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor