Individual
SUSAN L BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3790 OLD US 41 N STE A, VALDOSTA, GA 31602-6865
(229) 262-1000
Mailing address
2704 N OAK ST, BUILDING B-3, VALDOSTA, GA 31602-1744
(229) 257-0100
(229) 257-0050
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000865
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
592486097A
—
GA
Enumeration date
08/03/2006
Last updated
03/04/2024
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