Provider Demographics
NPI:1083630461
Name:VANBLARICOM, LINDA KATHERINE (MS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KATHERINE
Last Name:VANBLARICOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 149
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6343
Mailing Address - Country:US
Mailing Address - Phone:501-309-4858
Mailing Address - Fax:501-758-4459
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 149
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6343
Practice Address - Country:US
Practice Address - Phone:501-309-4858
Practice Address - Fax:501-758-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR77-36E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health