Provider Demographics
NPI:1811164650
Name:BRADFORD, JAMES HAMILTON (CCDC, CAC A/D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HAMILTON
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:CCDC, CAC A/D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13114 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:240-313-3378
Mailing Address - Fax:240-313-3239
Practice Address - Street 1:13114 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2741
Practice Address - Country:US
Practice Address - Phone:240-313-3378
Practice Address - Fax:240-313-3239
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDACO543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)