Provider Demographics
NPI:1144201393
Name:ULLOM, LINDA T (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:ULLOM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W COLLEGE TER
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4845
Mailing Address - Country:US
Mailing Address - Phone:301-663-6749
Mailing Address - Fax:301-631-2937
Practice Address - Street 1:5 N BENTZ ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4913
Practice Address - Country:US
Practice Address - Phone:301-631-2936
Practice Address - Fax:301-631-2937
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health