Provider Demographics
NPI:1619306099
Name:BRADSHAW, ESTHER (PARAPROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WILLOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-2834
Mailing Address - Country:US
Mailing Address - Phone:229-516-2497
Mailing Address - Fax:
Practice Address - Street 1:198 S MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-6370
Practice Address - Country:US
Practice Address - Phone:229-336-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health