Provider Demographics
NPI:1437493012
Name:BRADFIELD CLARKE, GINGER RENEE (MA CAADC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:RENEE
Last Name:BRADFIELD CLARKE
Suffix:
Gender:F
Credentials:MA CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29840 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-7361
Mailing Address - Country:US
Mailing Address - Phone:313-588-2971
Mailing Address - Fax:
Practice Address - Street 1:29840 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-7361
Practice Address - Country:US
Practice Address - Phone:313-588-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00592101YA0400X
MI6401009962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)