Provider Demographics
NPI:1386854628
Name:STOREY, LINDA PAYNE (PA-C, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:PAYNE
Last Name:STOREY
Suffix:
Gender:F
Credentials:PA-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3282
Mailing Address - Country:US
Mailing Address - Phone:734-629-7250
Mailing Address - Fax:
Practice Address - Street 1:2399 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1955
Practice Address - Country:US
Practice Address - Phone:248-474-6300
Practice Address - Fax:248-474-6370
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070804101YM0800X
MI5601007170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health