Provider Demographics
NPI:1275076135
Name:BODMAN, LINDA ANN (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:BODMAN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:PURVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:4310 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3100
Mailing Address - Country:US
Mailing Address - Phone:757-420-1000
Mailing Address - Fax:757-420-1003
Practice Address - Street 1:4310 INDIAN RIVER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3100
Practice Address - Country:US
Practice Address - Phone:757-420-1000
Practice Address - Fax:757-420-1003
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101467101YA0400X
VA0701003300101YP2500X
VA0717001085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional