Provider Demographics
NPI:1295857571
Name:BRADEN, LINDA DIANNE (LICDC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANNE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34545 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3010
Mailing Address - Country:US
Mailing Address - Phone:440-349-4490
Mailing Address - Fax:
Practice Address - Street 1:33595 BAINBRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2942
Practice Address - Country:US
Practice Address - Phone:440-349-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH892710101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)