Provider Demographics
NPI:1770029944
Name:BAGLEY, KAREN DEABBE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DEABBE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 OLD BRIDGE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3007
Mailing Address - Country:US
Mailing Address - Phone:571-412-3500
Mailing Address - Fax:571-412-3600
Practice Address - Street 1:2227 OLD BRIDGE RD STE 170
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3007
Practice Address - Country:US
Practice Address - Phone:571-412-3500
Practice Address - Fax:571-412-3600
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004683103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical