Provider Demographics
NPI:1841899515
Name:BRADFORD, JULIA C
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:C
Last Name:BRADFORD
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 1:5948 FISHER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5751
Mailing Address - Country:US
Mailing Address - Phone:980-549-1484
Mailing Address - Fax:910-766-6080
Practice Address - Street 1:5948 FISHER RD STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5751
Practice Address - Country:US
Practice Address - Phone:980-549-1484
Practice Address - Fax:910-766-6080
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician