Provider Demographics
NPI:1265029110
Name:BRADLEY, DEBBIE
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2236 BACK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-7307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2236 BACK VALLEY RD
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7307
Practice Address - Country:US
Practice Address - Phone:304-753-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator