| NPI | 1063757326 |
|---|---|
| Former Name | KELLY ELIZABETH BRADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701004942) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102540) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2012-11-27 |