Provider Demographics
NPI:1518461854
Name:BRADDY, BRIANNA GAYLE (LCSW, LCASA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:GAYLE
Last Name:BRADDY
Suffix:
Gender:F
Credentials:LCSW, LCASA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:GAYLE
Other - Last Name:GERDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA, LCASA
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1104A S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3134
Practice Address - Country:US
Practice Address - Phone:336-242-2450
Practice Address - Fax:336-249-9920
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27141101YA0400X
NCP0122521041C0700X
NCC0160301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)