Provider Demographics
NPI:1093421422
Name:LINNEN, LASHONDA ALIESHIA
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:ALIESHIA
Last Name:LINNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 RED SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-5701
Mailing Address - Country:US
Mailing Address - Phone:803-230-8874
Mailing Address - Fax:
Practice Address - Street 1:857 RED SPRUCE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-5701
Practice Address - Country:US
Practice Address - Phone:803-230-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty