Active NPI
Angelia Pinckard Bradley, MED LPC MHSP
- Professional Counselor
- Johnson City, TN
National Provider Identifier
1982708665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPCMHSP2004
- Practice address
- 210 Joe Hale Dr
Johnson City, TN 37615-3866 - Phone
- (423) 677-7824
- NPI assigned
- Sep 12, 2006
- Last updated
- Sep 15, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPCMHSP2004 | TN | Primary |
Addresses
Primary practice location
210 Joe Hale Dr
Johnson City, TN 37615-3866
Mailing address
210 Joe Hale Dr
Johnson City, TN 37615-3866
Phone (423) 677-7824
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 620582605 | Other | CARITEN SENIOR PPO | |
| 620582605 | Other | CARITEN PHP HMO | |
| 620582605 | Other | CARITEN SENIOR HMO | |
| 620582605 | Other | THREE RIVERS PROVI GROUP | |
| 620582605 | Other | CARITEN PHP PPO | |
| 4120940 | Other | MAGELLAN NAVIGATOR | |
| 4120940 | Other | MAGELLAN SUMMIT | |
| 620582605 | Other | CORPHEALTH | |
| 4120940 | Other | MAGELLAN PINNACLE | |
| 620582605 | Other | TRICARE SOUTH | |
| 334969 | Other | VALUEOPTIONS GROUP | |
| 620582605 | Other | CARITEN PHP POS | |
| 010277582 | Other | VIRGINIA MEDICAID CTC | |
| 9427660 | Other | PHCS | |
| 620582605 | Other | CARITEN PHP WORKCO | |
| 620582605 | Other | INITIAL GROUP GROUP | |
| 620582605 | Other | CARITEN PPO LEASE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPCMHSP2004 | TN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473897600000",
"number": "1982708665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 JOE HALE DR",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376153866",
"telephone_number": "423-677-7824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 JOE HALE DR",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376153866",
"telephone_number": "423-677-7824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "ANGELIA",
"middle_name": "PINCKARD",
"credential": "MED LPC MHSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-12",
"last_updated": "2016-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "LPCMHSP2004",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN SENIOR PPO",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN PHP HMO",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN SENIOR HMO",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THREE RIVERS PROVI GROUP",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN PHP PPO",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN NAVIGATOR",
"identifier": "4120940",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN SUMMIT",
"identifier": "4120940",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN PINNACLE",
"identifier": "4120940",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE SOUTH",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS GROUP",
"identifier": "334969",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN PHP POS",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA MEDICAID CTC",
"identifier": "010277582",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9427660",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN PHP WORKCO",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INITIAL GROUP GROUP",
"identifier": "620582605",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN PPO LEASE",
"identifier": "620582605",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.