Individual
BRADLEY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LGSW
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
BP00947033
WV
171M00000X
Case Manager/Care Coordinator
—
—
225700000X
Massage Therapist
2012-2932
WV
225700000X
Massage Therapist
M04990
MD
Other
Enumeration date
06/03/2014
Last updated
04/01/2025
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