Individual
KEVIN BRADSHAW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
620 JOHN PAUL JONES CIR, CODE-1121, PORTSMOUTH, VA 23708-2111
(757) 953-5861
Mailing address
303 EFFINGHAM ST, APT-8-E, PORTSMOUTH, VA 23704-2314
(757) 362-7774
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000003054
TN
Other
Enumeration date
01/20/2006
Last updated
07/08/2007
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