Provider Demographics
NPI:1821895590
Name:BENDALL, BRADLEY (CDCA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BENDALL
Suffix:
Gender:
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 DAYTON SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1462
Mailing Address - Country:US
Mailing Address - Phone:937-862-0008
Mailing Address - Fax:
Practice Address - Street 1:7373 DAYTON SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1462
Practice Address - Country:US
Practice Address - Phone:937-862-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.191796101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)