Provider Demographics
NPI:1407947633
Name:GOLD, LINDA LEE (MED, LMSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:GOLD
Suffix:
Gender:F
Credentials:MED, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S CREYTS RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8235
Mailing Address - Country:US
Mailing Address - Phone:517-323-8255
Mailing Address - Fax:
Practice Address - Street 1:1020 S CREYTS RD
Practice Address - Street 2:SUITE 307
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8235
Practice Address - Country:US
Practice Address - Phone:517-323-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008160101YP2500X
MI6301003846103T00000X
MI68010192511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical