Provider Demographics
NPI:1114268844
Name:BRADFORD ASSOCIATES NC LLC
Entity type:Organization
Organization Name:BRADFORD ASSOCIATES NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-944-0938
Mailing Address - Street 1:250 MAGNOLIA SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2226
Mailing Address - Country:US
Mailing Address - Phone:910-944-0938
Mailing Address - Fax:910-944-0940
Practice Address - Street 1:250 MAGNOLIA SQUARE CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2226
Practice Address - Country:US
Practice Address - Phone:910-944-0938
Practice Address - Fax:910-944-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5580251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty