Individual provider · Type 1 NPI
Datrese Monique Bradley, LCPC
Professional Counselor · Carbondale, IL
NPI number
1053059949
Active
Practice location
103 N Rod Ln
Carbondale, IL 62901-2031
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 180.014457 (IL) |
Professional Counselor: Definition to come...
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About NPI 1053059949
Datrese Monique Bradley, LCPC's National Provider Identifier is 1053059949, issued on May 22, 2022. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Carbondale, IL. The record was last updated on May 22, 2022.