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MS. ANITRA LYNETTE BRADFORD LAC
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1124218177
Individual Registrant:MS. ANITRA LYNETTE BRADFORD LAC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
621 E NORTH ST MAGNOLIA, AR 71753-3120 US
Tel: 870-234-0739 Fax: --
Tel: 870-234-0739 Fax: --
Contact information for business:
1600 ALDERSGATE RD STE 200 LITTLE ROCK, AR 72205-6676 US
Tel: 501-661-0720 Fax: --
Tel: 501-661-0720 Fax: --
Registration Information:
NPI: 1124218177
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | AR | A0710078 |
| Y | 101YP2500X | Behavioral Health & Social Service Providers Counselor | AR | P1012084 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
