Provider Demographics
NPI:1164632337
Name:BIRD, LINDA CAROL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROL
Last Name:BIRD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 HONEYSUCKLE CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8530
Mailing Address - Country:US
Mailing Address - Phone:704-658-5320
Mailing Address - Fax:
Practice Address - Street 1:181 HONEYSUCKLE CREEK LOOP
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8530
Practice Address - Country:US
Practice Address - Phone:704-658-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010635531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N65400005Medicare ID - Type UnspecifiedMEMBER NUMBER