Provider Demographics
NPI:1003831413
Name:MOFFATT, LINDA K (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W DELMAR AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4214
Mailing Address - Country:US
Mailing Address - Phone:618-791-8006
Mailing Address - Fax:618-243-6558
Practice Address - Street 1:611 W DELMAR AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4214
Practice Address - Country:US
Practice Address - Phone:618-791-8006
Practice Address - Fax:618-243-6558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional