Provider Demographics
NPI:1245842764
Name:BRADBERRY, SARAH ELIZABETH (LAC)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BRADBERRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5609
Mailing Address - Country:US
Mailing Address - Phone:501-749-8169
Mailing Address - Fax:
Practice Address - Street 1:513 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5329
Practice Address - Country:US
Practice Address - Phone:501-777-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P2012129101YP2500X
ARA19011008101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional