Individual
DIANE K. BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
367 GREAT FOREST RD, GRIMESLAND, NC 27837-9049
(252) 916-4613
(252) 328-4868
Mailing address
367 GREAT FOREST RD, GRIMESLAND, NC 27837-9049
(252) 916-4613
(252) 328-4868
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7216
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11767847
CAQH
PA
Enumeration date
05/13/2008
Last updated
07/17/2012
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