Individual
DATRESE MONIQUE BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
103 N ROD LN, CARBONDALE, IL 62901-2031
(618) 203-6925
Mailing address
103 N ROD LN, CARBONDALE, IL 62901-2031
(618) 203-6925
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.014457
IL
Other
Enumeration date
05/22/2022
Last updated
05/22/2022
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