Individual
RENATE MARIE BRADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP-A
Contact information
Practice address
416 S MAIN ST, ESTILL SPRINGS, TN 37330-4037
(276) 617-0512
Mailing address
416 S MAIN ST, ESTILL SPRINGS, TN 37330-4037
(276) 617-0512
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0732004484
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS LICENSE
VA
Enumeration date
06/26/2019
Last updated
06/26/2019
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