Provider Demographics
NPI:1376522680
Name:GRANDE, LINDA M (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:GRANDE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 YELLOWWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4622
Mailing Address - Country:US
Mailing Address - Phone:410-367-2950
Mailing Address - Fax:410-367-2951
Practice Address - Street 1:4801 YELLOWWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4622
Practice Address - Country:US
Practice Address - Phone:410-367-2950
Practice Address - Fax:410-367-2951
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional