Datrese Monique Bradley, LCPC
NPI #1053059949 in Carbondale, Illinois
Provider Information
- NPI Number
- 1053059949
- Entity Type
- Individual
- Name
- Datrese Monique Bradley, LCPC
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Credential
- LCPC
- Enumeration Date
- May 22, 2022
- Last Updated
- May 22, 2022
Practice Location
- Address
- 103 N ROD LN
- City
- Carbondale
- State
- Illinois
- ZIP Code
- 62901-2031
- Phone
- (618) 203-6925
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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