Provider Demographics
NPI:1245520444
Name:BRADEN, VIRGINIA MAY LYNN (LPC, CAADC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MAY LYNN
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:MAY LYNN
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC
Mailing Address - Street 1:1035 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2929
Mailing Address - Country:US
Mailing Address - Phone:989-358-0673
Mailing Address - Fax:
Practice Address - Street 1:208 S STATE ST
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1635
Practice Address - Country:US
Practice Address - Phone:989-739-2550
Practice Address - Fax:989-358-3750
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151108101YA0400X
MIC-02859101YA0400X
MI6401012629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)