Provider Demographics
NPI:1740963842
Name:EMILIE BRADLEY LPC ATR PLLC
Entity type:Organization
Organization Name:EMILIE BRADLEY LPC ATR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-529-8543
Mailing Address - Street 1:PO BOX 21154
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0117
Mailing Address - Country:US
Mailing Address - Phone:540-772-1872
Mailing Address - Fax:540-772-4830
Practice Address - Street 1:4220 CYPRESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8403
Practice Address - Country:US
Practice Address - Phone:540-772-1872
Practice Address - Fax:540-772-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty