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 1:1330 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2453
Mailing Address - Country:US
Mailing Address - Phone:276-873-2577
Mailing Address - Fax:
Practice Address - Street 1:1330 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2453
Practice Address - Country:US
Practice Address - Phone:276-873-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional