Provider Demographics
NPI:1093922429
Name:IKLE, LINDA OLDHAM (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:OLDHAM
Last Name:IKLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 WELLINGTON AVE
Mailing Address - Street 2:UNIT H
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7747
Mailing Address - Country:US
Mailing Address - Phone:910-793-6144
Mailing Address - Fax:910-793-6140
Practice Address - Street 1:1606 WELLINGTON AVE
Practice Address - Street 2:UNIT H
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7747
Practice Address - Country:US
Practice Address - Phone:910-793-6144
Practice Address - Fax:910-793-6140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3302103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent