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1396216404
BRADLEY HIGGINBOTHAM
LAKE CHARLES, LA
NPI
1396216404
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-12-16
Last Update Date
2018-12-16
Business Address
BRADLEY HIGGINBOTHAM MSSA
145 VICTORIA DR
LAKE CHARLES, LA 70611-4641
Phone number: 337-855-9773
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Mailing Address
BRADLEY HIGGINBOTHAM MSSA
209 PARK AVE
LAKE CHARLES, LA 70601-5967
Phone number: 337-304-3719
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