Provider Demographics
NPI:1104940261
Name:MCLAUGHLIN, LINDA MARIE (OWNER)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-0473
Mailing Address - Country:US
Mailing Address - Phone:910-734-8549
Mailing Address - Fax:910-369-0209
Practice Address - Street 1:28300 CRUMPTOWN ROAD
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396
Practice Address - Country:US
Practice Address - Phone:910-734-8549
Practice Address - Fax:910-369-0209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600560027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301159HMedicaid
NC8301159Medicaid
NC8301159BMedicaid
NC8301159GMedicaid