Healthcare Provider Details

I. General information

NPI: 1972892685
Provider Name (Legal Business Name): KAREN LYNN BRADLEY JACKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MARTIN ST
POUNDING MILL VA
24637-4169
US

IV. Provider business mailing address

268 MARTIN ST
POUNDING MILL VA
24637-4169
US

V. Phone/Fax

Practice location:
  • Phone: 276-873-2577
  • Fax: 276-598-4670
Mailing address:
  • Phone: 276-873-2577
  • Fax: 276-598-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: