Provider Demographics
NPI:1245780436
Name:HILL, BRADFORD (MED, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:MED, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 BIG SANDY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5790
Mailing Address - Country:US
Mailing Address - Phone:919-649-7734
Mailing Address - Fax:
Practice Address - Street 1:6108 BIG SANDY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5790
Practice Address - Country:US
Practice Address - Phone:919-649-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health