Provider Demographics
NPI:1699544809
Name:SMITH, BRADLEY (MA LADAC II)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PENNINGTON CENTRE BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3253
Mailing Address - Country:US
Mailing Address - Phone:615-362-1387
Mailing Address - Fax:
Practice Address - Street 1:330 PENNINGTON CENTRE BLVD APT 206
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3253
Practice Address - Country:US
Practice Address - Phone:615-362-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)