Provider Demographics
NPI:1124288097
Name:HORNSBY, LINDA ANN (TLLP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3230
Mailing Address - Country:US
Mailing Address - Phone:248-762-0633
Mailing Address - Fax:
Practice Address - Street 1:24750 SWANSON RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5320
Practice Address - Country:US
Practice Address - Phone:248-762-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical