Individual
KEVIN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
12408 ALEXANDER CORNELL DR, FAIRFAX, VA 22033-2414
(703) 658-9054
Mailing address
12408 ALEXANDER CORNELL DR, FAIRFAX, VA 22033-2414
(703) 658-9054
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904010765
VA
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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