Organization
BRADLEY KORNEGAY, LCSW, LCAS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY KORNEGAY MSW, LCSW, LCAS (OWNER)
(252) 412-3207
Entity
Organization
Contact information
Practice address
925D CONFERENCE DR, GREENVILLE, NC 27858-5971
(252) 412-3207
(252) 689-2996
Mailing address
PO BOX 2899, GREENVILLE, NC 27836-0899
(252) 412-3207
(252) 689-2996
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-2786
NC
1041C0700X
Clinical Social Worker
Primary
C009346
NC
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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