Healthcare Provider Details

I. General information

NPI: 1326954892
Provider Name (Legal Business Name): LINDA NICOLE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 JERSEY LN
CONCORD VA
24538-3364
US

IV. Provider business mailing address

437 JERSEY LN
CONCORD VA
24538-3364
US

V. Phone/Fax

Practice location:
  • Phone: 814-580-6989
  • Fax:
Mailing address:
  • Phone: 814-580-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA NICOLE BAKELY
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential: DSW, LISW-CP, LCSW
Phone: 814-580-6989