Provider Demographics
NPI:1255843850
Name:BRADSHAW, THOMAS BRICE (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRICE
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8949
Mailing Address - Country:US
Mailing Address - Phone:844-345-2256
Mailing Address - Fax:844-345-2256
Practice Address - Street 1:117 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8949
Practice Address - Country:US
Practice Address - Phone:844-345-2256
Practice Address - Fax:844-345-2256
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional