Provider Demographics
NPI:1427402791
Name:VATNIKAJ, LINDA (LLPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VATNIKAJ
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:DJOKAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:52208 HEATHERSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3552
Mailing Address - Country:US
Mailing Address - Phone:586-246-2721
Mailing Address - Fax:
Practice Address - Street 1:175 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1562
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018519104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker