Provider Demographics
NPI:1093424673
Name:BRADLEY, EMILIE ADELE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:ADELE
Last Name:BRADLEY
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 1:4069 POSTAL DR.
Mailing Address - Street 2:PO BOX 21154
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-9998
Mailing Address - Country:US
Mailing Address - Phone:540-494-2452
Mailing Address - Fax:
Practice Address - Street 1:1325 JAMISON AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2015
Practice Address - Country:US
Practice Address - Phone:833-952-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor