Provider Demographics
NPI:1407245566
Name:BRADACS, JESSICA (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:BRADACS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 CORPORATE OFFICE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-5002
Mailing Address - Country:US
Mailing Address - Phone:248-714-9289
Mailing Address - Fax:734-780-3005
Practice Address - Street 1:1100 CORPORATE OFFICE DR STE 300
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5002
Practice Address - Country:US
Practice Address - Phone:248-714-9289
Practice Address - Fax:734-780-3005
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional