Basic Information
| Provider Information | |||||||||
| NPI: | 1124590401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | VALICIA | ||||||||
| MiddleName: | LOUVENIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 CLEVELAND RD | ||||||||
| Address2: | |||||||||
| City: | BOYCE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714099284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187935974 | ||||||||
| FaxNumber: | 3187935223 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 CLEVELAND RD | ||||||||
| Address2: | |||||||||
| City: | BOYCE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714099284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187935674 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2018 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10809 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.