Provider Demographics
NPI:1740585058
Name:BRADFORD, RUBY CAROL YVONNE (MS)
Entity Type:Individual
Prefix:MS
First Name:RUBY CAROL YVONNE
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:BRADFORD
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:752 COUNTY ROAD 1101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-5249
Mailing Address - Country:US
Mailing Address - Phone:334-369-9365
Mailing Address - Fax:334-243-5006
Practice Address - Street 1:752 COUNTY ROAD 1101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-5249
Practice Address - Country:US
Practice Address - Phone:334-369-9365
Practice Address - Fax:334-243-5006
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor