Provider Demographics
NPI:1306999016
Name:VICK, LINDA T (LCSW,)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:T
Last Name:VICK
Suffix:
Gender:F
Credentials:LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 SNOW FALL PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1073
Mailing Address - Country:US
Mailing Address - Phone:915-449-8149
Mailing Address - Fax:915-849-0187
Practice Address - Street 1:3316 SNOW FALL PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1073
Practice Address - Country:US
Practice Address - Phone:915-449-8149
Practice Address - Fax:915-849-0187
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical