Individual
HEATHER BRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-MHSP
Contact information
Practice address
441 CLAY ST, KINGSPORT, TN 37660-3693
(423) 247-4536
Mailing address
PO BOX 1323, KINGSPORT, TN 37662-1323
(423) 247-4536
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3949
TN
Other
Enumeration date
09/20/2017
Last updated
09/20/2017
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