Provider Demographics
NPI:1013173830
Name:OLDHAM, LANCE BRADLEY (LPC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:BRADLEY
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 W MARKET ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1399
Mailing Address - Country:US
Mailing Address - Phone:336-209-5315
Mailing Address - Fax:336-665-6188
Practice Address - Street 1:3707 W MARKET ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1399
Practice Address - Country:US
Practice Address - Phone:336-209-5315
Practice Address - Fax:336-665-6188
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional