Healthcare Provider Details

I. General information

NPI: 1376524827
Provider Name (Legal Business Name): LINDA TAYLOR ELY RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BROAD ST
DUBLIN VA
24084-3201
US

IV. Provider business mailing address

125 BROAD ST P.O. BOX 1183
DUBLIN VA
24084-3201
US

V. Phone/Fax

Practice location:
  • Phone: 540-674-4506
  • Fax: 540-674-4507
Mailing address:
  • Phone: 540-674-4506
  • Fax: 540-674-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0015-000533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: