Provider Demographics
NPI:1336106087
Name:DECKER, LINDA LEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEA
Last Name:DECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:L
Other - Middle Name:LEA
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:280 W MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4304
Mailing Address - Country:US
Mailing Address - Phone:919-870-1470
Mailing Address - Fax:919-870-8917
Practice Address - Street 1:280 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4304
Practice Address - Country:US
Practice Address - Phone:919-870-1470
Practice Address - Fax:919-870-8917
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000216NC1041C0700X
NC301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist