Basic Information
| Provider Information | |||||||||
| NPI: | 1245520444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADEN | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | MAY LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, CAADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRADEN | ||||||||
| OtherFirstName: | VIRGINIA | ||||||||
| OtherMiddleName: | MAY LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICDC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1035 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497072929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893580673 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 208 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | OSCODA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487501635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897392550 | ||||||||
| FaxNumber: | 9893583750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2011 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 151108 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | C-02859 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 6401012629 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.