Provider Demographics
NPI:1538803192
Name:BRADFIELD, TANYA (LMSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SWEET OLIVE DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7355
Mailing Address - Country:US
Mailing Address - Phone:843-530-2766
Mailing Address - Fax:
Practice Address - Street 1:110 SWEET OLIVE DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7355
Practice Address - Country:US
Practice Address - Phone:843-530-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14835104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker