Provider Demographics
NPI:1568519536
Name:RADEKER, LINDA SMOOT (M A , LPC, MAC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SMOOT
Last Name:RADEKER
Suffix:
Gender:F
Credentials:M A , LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MARION ST
Mailing Address - Street 2:SUITE 321, CHARLESTON PLACE MALL
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5091
Mailing Address - Country:US
Mailing Address - Phone:704-487-1055
Mailing Address - Fax:704-487-1056
Practice Address - Street 1:201 W MARION ST
Practice Address - Street 2:SUITE 321, CHARLESTON PLACE MALL
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5091
Practice Address - Country:US
Practice Address - Phone:704-487-1055
Practice Address - Fax:704-487-1056
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 2260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102236Medicaid