Provider Demographics
NPI:1699848960
Name:BRADSHAW EARL, CHRISTINE D (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:BRADSHAW EARL
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:224 GREAT BRIDGE BLVD
Mailing Address - Street 2:CITY OF CHESAPEAKE TA CHES COMM SERVICE BOARD
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-547-9334
Mailing Address - Fax:757-819-6292
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:CITY OF CHESAPEAKE TA CHES COMM SERVICE BOARD
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040021731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA324054OtherTRICARE
VA033147OtherVALUE OPTIONS
VA176185OtherANTHEM TRIGON
VA920225Medicaid
VA920225Medicaid