Individual
ANDREA BULLOCK BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S., LPC
Contact information
Practice address
4500 FORT JACKSON BLVD STE 110, COLUMBIA, SC 29209-1134
(803) 216-1107
Mailing address
4500 FORT JACKSON BLVD STE 110, COLUMBIA, SC 29209-1134
(803) 216-1107
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
5277
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC1122
—
SC
Enumeration date
09/22/2008
Last updated
09/23/2021
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