Provider Demographics
NPI:1346232378
Name:BRADHAM, JOSEPH WILLIAM (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:BRADHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 WINDWARD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8964
Mailing Address - Country:US
Mailing Address - Phone:843-762-0399
Mailing Address - Fax:
Practice Address - Street 1:1180 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 251
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3382
Practice Address - Country:US
Practice Address - Phone:843-343-5562
Practice Address - Fax:843-766-3351
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist