Provider Demographics
NPI:1740695501
Name:BRADLEY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 FOREST HILLS RD W
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3680
Mailing Address - Country:US
Mailing Address - Phone:252-265-9200
Mailing Address - Fax:
Practice Address - Street 1:2130 FOREST HILLS RD W
Practice Address - Street 2:SUITE A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3680
Practice Address - Country:US
Practice Address - Phone:252-265-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0089011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical