Individual
DR. MICHAEL BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
2450 DELANEY RD, WILMINGTON, NC 28403-6062
(910) 762-9083
(910) 763-6339
Mailing address
2450 DELANEY RD, WILMINGTON, NC 28403-6062
(910) 762-9083
(910) 763-6339
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
977
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03457
BC/BS
NC
01
—
071992
VALU OPTIONS
NC
01
—
126105
COMPSYCH
NC
05
—
6000593
—
NC
Enumeration date
02/22/2006
Last updated
09/11/2012
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