Provider Information for 1689372757
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BRADLEY CRAIN LPC,CRC, NCC
Sex: Male
NPI: 1689372757
Last Updated: 2023-09-15
Certification Date: 2023-09-15
Certification Date: 2023-09-15
Details
| Name | Value | ||||||||||||
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| NPI | 1689372757 | ||||||||||||
| Enumeration Date | 2023-02-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 12155 FIELDING PL WALDORF, MD 20601-4720 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 12155 FIELDING PL WALDORF, MD 20601-4720 United States Phone: 202-867-4977 | Fax: | ||||||||||||
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