| Bradley Kornegay, Lcsw, Lcas, Pllc | |
|
925d Conference Dr Greenville NC 27858-5971 | |
| (252) 412-3207 | |
| (252) 689-2996 |
| Full Name | Bradley Kornegay, Lcsw, Lcas, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 925d Conference Dr, Greenville, North Carolina |
| Authorized Official Name and Position | Bradley Kornegay (OWNER) |
| Authorized Official Contact | 2524123207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bradley Kornegay, Lcsw, Lcas, Pllc Po Box 2899 Greenville NC 27836-0899 Ph: (252) 412-3207 | Bradley Kornegay, Lcsw, Lcas, Pllc 925d Conference Dr Greenville NC 27858-5971 Ph: (252) 412-3207 |
| NPI Number | 1225422686 |
|---|---|
| Provider Enumeration Date | 03/24/2015 |
| Last Update Date | 03/24/2015 |
| Medicare PECOS PAC ID | 6800207036 |
|---|---|
| Medicare Enrollment ID | O20201119001811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225422686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCAS-2786 (North Carolina) | Secondary |
| 1041C0700X | Social Worker - Clinical | C009346 (North Carolina) | Primary |
| Provider Name | Bradley Kornegay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811235989 PECOS PAC ID: 6103144142 Enrollment ID: I20150423000434 |
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