Provider Demographics
NPI:1457668543
Name:BRADFORD ASSOCIATES
Entity Type:Organization
Organization Name:BRADFORD ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINNE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:BILODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, CCS
Authorized Official - Phone:910-692-2947
Mailing Address - Street 1:103 BRADFORD COURT
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-692-2947
Mailing Address - Fax:910-692-4147
Practice Address - Street 1:103 BRADFORD COURT
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-692-2947
Practice Address - Fax:910-692-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC234101YA0400X
NC8093101YM0800X, 106H00000X
NCA7667101YM0800X
NC5329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty