Provider Demographics
NPI:1245996578
Name:WORD, BRADLEY POWELL JR (LPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:POWELL
Last Name:WORD
Suffix:JR
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 1:707 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-6214
Mailing Address - Country:US
Mailing Address - Phone:334-444-2715
Mailing Address - Fax:
Practice Address - Street 1:707 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-6214
Practice Address - Country:US
Practice Address - Phone:334-444-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional