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General NPI Number Information
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NPI Number | 1275076135
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Entity Type | Individual
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Provider Name | LINDA ANN BODMAN LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 4310 INDIAN RIVER RD SUITE 1A
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3100
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Country | US
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Telephone | 757-420-1000
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Fax | 757-420-1003
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Provider Business Mailing Address
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Address Line | 4310 INDIAN RIVER RD SUITE 1A
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3100
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Country | US
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Telephone | 757-420-1000
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Fax | 757-420-1003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710101467
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003300
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001085
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License Number State | VA
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