Provider Demographics
NPI:1144312273
Name:BAGLEY, HOPE BETH (PHD; LCP; LPC)
Entity type:Individual
Prefix:DR
First Name:HOPE
Middle Name:BETH
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:PHD; LCP; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 PANTOPS CTR # 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8665
Mailing Address - Country:US
Mailing Address - Phone:434-760-5334
Mailing Address - Fax:434-977-6323
Practice Address - Street 1:690 BERKMAR CIR STE 3
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-227-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001568101YP2500X
VA0810000174103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
7266244OtherAETNA
VA7714904Medicaid