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Individual

GENEVA BRADSHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPCC

Contact information

Practice address
704 SAINT PAUL RD, CAMDEN, SC 29020-1562
(270) 799-6628
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
Primary
168477
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100417810
KY
Enumeration date
02/07/2014
Last updated
01/21/2025
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