Individual
MR. DERRICK BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LCADC
Contact information
Practice address
3265 HIGHWAY 26, CORBIN, KY 40701-9047
(606) 555-1212
Mailing address
3265 HIGHWAY 26 STE C, CORBIN, KY 40701-9047
(606) 219-8130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
167193
KY
101YP2500X
Professional Counselor
Primary
104136
KY
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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