Provider Demographics
NPI:1285971069
Name:BRADIGAN, BRIAN M (LCASA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:BRADIGAN
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2140
Mailing Address - Country:US
Mailing Address - Phone:704-476-4106
Mailing Address - Fax:704-845-4860
Practice Address - Street 1:631 BRAWLEY SCHOOL RD
Practice Address - Street 2:STE 200B, PMB301
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6204
Practice Address - Country:US
Practice Address - Phone:704-884-2060
Practice Address - Fax:704-854-4860
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3042A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)