Provider Demographics
NPI:1326189713
Name:KRUEGER, LINDA HAYNSWORTH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HAYNSWORTH
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:204 IDOL DRIVE
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27361-0338
Mailing Address - Country:US
Mailing Address - Phone:336-474-1276
Mailing Address - Fax:336-472-4605
Practice Address - Street 1:2557 CEDAR DELL LN
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9113
Practice Address - Country:US
Practice Address - Phone:252-522-0811
Practice Address - Fax:252-527-4422
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC699101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105104Medicaid