Provider Demographics
NPI:1528478864
Name:LYN-BRADLEY, DENISE ELECIA (LPC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ELECIA
Last Name:LYN-BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 210
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:404-536-8813
Mailing Address - Fax:675-669-1815
Practice Address - Street 1:156 HAYES CIRCLE
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273
Practice Address - Country:US
Practice Address - Phone:404-536-8813
Practice Address - Fax:678-669-1815
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007638101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor