Provider Demographics
NPI:1164554333
Name:PIERCE, LINDA KAY (LCWS, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAY
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LCWS, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 PRINCESS PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3333
Mailing Address - Country:US
Mailing Address - Phone:910-251-8130
Mailing Address - Fax:910-251-8491
Practice Address - Street 1:4006 PRINCESS PLACE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3333
Practice Address - Country:US
Practice Address - Phone:910-251-8130
Practice Address - Fax:910-251-8491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC004092OtherSTATE LICENSE (LCSW)
NC6003605Medicaid
NC141XEOtherBCBS PIN