Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1184832883 |
---|---|
Provider Name | Bradley Allen West |
First Address | Fayetteville, NC 28311-9333 |
Second Address | Fort Bragg, NC 28310-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |