Datrese Monique Bradley, LCPC
NPI 1053059949ActiveIndividual· Counselor, Professional· Carbondale, IL
Counselor, Professional (LCPC) in Carbondale, Illinois, licensed in IL, with an NPI issued in May 2022. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1053059949 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LCPC |
| Sole proprietor | Yes |
| NPI issued | May 22, 2022 |
| Last updated in NPPES | May 22, 2022 |
| Certified by provider | May 22, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 180.014457 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (IL) |
|---|
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