Provider Demographics
NPI:1871675439
Name:BRADLEY, NANCY JONES (ED S)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JONES
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-9663
Mailing Address - Country:US
Mailing Address - Phone:803-408-8496
Mailing Address - Fax:
Practice Address - Street 1:2715 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6818
Practice Address - Country:US
Practice Address - Phone:803-898-4777
Practice Address - Fax:803-898-4855
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC001144 LMSW104100000X
SC1502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist