Provider Demographics
NPI:1508050030
Name:BRADSHAW, LINDA KATHLEEN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KATHLEEN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3161
Mailing Address - Country:US
Mailing Address - Phone:828-324-2776
Mailing Address - Fax:828-397-3533
Practice Address - Street 1:2620 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3161
Practice Address - Country:US
Practice Address - Phone:828-324-2776
Practice Address - Fax:828-397-3533
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3039101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102737Medicaid