Provider Demographics
NPI:1972892685
Name:BRADLEY/JACKSON, KAREN LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:BRADLEY/JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CEDAR VALLEY
Mailing Address - Street 2:DRIVE HEALING WATERS COUNSELING CENTER P.O. BOX 426
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609
Mailing Address - Country:US
Mailing Address - Phone:276-963-0001
Mailing Address - Fax:276-963-0005
Practice Address - Street 1:1113 CEDAR VALLEY DR.
Practice Address - Street 2:HEALING WATERS COUNSELING CENTER
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-963-0001
Practice Address - Fax:276-963-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional