Provider Demographics
NPI:1336179456
Name:BRADLEY, APRIL RAIN (PHD)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:RAIN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 ELMWOOD AVE STE 300B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2150
Mailing Address - Country:US
Mailing Address - Phone:803-250-5109
Mailing Address - Fax:803-369-6109
Practice Address - Street 1:1331 ELMWOOD AVE STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2150
Practice Address - Country:US
Practice Address - Phone:803-250-5109
Practice Address - Fax:803-369-6109
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1192103T00000X
ND387103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13811Medicaid