Individual
DIANNE M BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 PAR LN STE 102, ELIZABETHTOWN, KY 42701-9059
(423) 817-8818
Mailing address
121 LAVENIA LN, MAGNOLIA, KY 42757-7823
(423) 817-8818
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904008413
VA
1041C0700X
Clinical Social Worker
Primary
256419
KY
1041C0700X
Clinical Social Worker
5837
TN
1041C0700X
Clinical Social Worker
LC50081103
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100822370
—
KY
Enumeration date
10/17/2011
Last updated
01/10/2023
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