Jessica Bradley, LCMHCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A16116 Issued in NC

Practice address

104 East Old US Hwy 74/76
Lake Waccamaw, NC 28450

Phone

(910) 646-3083

NPI assigned

Apr 20, 2021

Last updated

Apr 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boys & Girls Homes of NC, Inc

  • Foster Care Agency
  • Lake Waccamaw, NC
  • NPI 1245542745
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1518548577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 127",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "284500127",
            "telephone_number": "910-646-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 EAST OLD US HWY 74/76",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "28450",
            "telephone_number": "910-646-3083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "JESSICA",
        "credential": "LCMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A16116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jessica.bradley@bghnc.org",
            "affiliation": "N",
            "endpointDescription": "jessica.bradley@bghnc.org",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "104 East Old US Hwy 74/76",
            "city": "Lake Waccamaw",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Blsrph, Inc (Village Prescription Center)
• Boys & Girls Homes of NC, Inc
• Brenton Management Group Inc
• Eugene Glenn Brown Jr., RPH
• Egb Enterjprises (Village Prescription Center)
• Egb Enterprises Inc (Village Prescription Center)
• Etcare Home Quality Management, Inc (Lake Waccamaw Senior Living)

• Professional Counselor in Lake Waccamaw, NC
• Providers in Lake Waccamaw, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.