Provider Demographics
NPI:1619586948
Name:BRADLEY, ASHLYN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LONG GROVE DR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8422
Mailing Address - Country:US
Mailing Address - Phone:540-538-5790
Mailing Address - Fax:
Practice Address - Street 1:753 JOHNNIE DODDS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3054
Practice Address - Country:US
Practice Address - Phone:540-538-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC118521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical