Provider Demographics
NPI:1134489636
Name:LINDA KILLIAN, LCSW, LCAS PC
Entity Type:Organization
Organization Name:LINDA KILLIAN, LCSW, LCAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:919-732-3504
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:960 CORPORATE DRIVE, SUITE 401
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-0772
Mailing Address - Country:US
Mailing Address - Phone:919-732-3504
Mailing Address - Fax:919-732-3557
Practice Address - Street 1:960 CORPORATE DR STE 401
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8560
Practice Address - Country:US
Practice Address - Phone:919-732-3504
Practice Address - Fax:919-732-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002075261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002362Medicaid