Provider Demographics
NPI:1326061326
Name:MINOR, LINDA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:R
Last Name:MINOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HANSON AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3126
Mailing Address - Country:US
Mailing Address - Phone:540-361-4330
Mailing Address - Fax:540-361-4331
Practice Address - Street 1:305 HANSON AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3126
Practice Address - Country:US
Practice Address - Phone:540-361-4330
Practice Address - Fax:540-361-4331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4763-0001OtherCARE FIRST BCBS
VA152672OtherMHN
VA89-1497-4Medicaid
VA089122OtherSENTARA-VETRI
VA291952OtherBLUE CROSS BLUE SHIELD
VA512334OtherNCPPO
VA4763-0001OtherCARE FIRST BCBS