Provider Demographics
NPI:1164570859
Name:WILLSON, LINDA MARY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARY
Last Name:WILLSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 SOUTHSIDE BLVD.
Mailing Address - Street 2:APT. 1213
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8497
Mailing Address - Country:US
Mailing Address - Phone:904-538-9418
Mailing Address - Fax:
Practice Address - Street 1:8700 SOUTHSIDE BLVD.
Practice Address - Street 2:APT. 1213
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8497
Practice Address - Country:US
Practice Address - Phone:904-538-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0002487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health