Provider Demographics
NPI:1568587434
Name:MILLSAPS-LINGER, PATRICIA MAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MAE
Last Name:MILLSAPS-LINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 FULTON RD. NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3523
Mailing Address - Country:US
Mailing Address - Phone:330-456-1899
Mailing Address - Fax:330-456-4191
Practice Address - Street 1:1829 FULTON RD. NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3523
Practice Address - Country:US
Practice Address - Phone:330-456-1899
Practice Address - Fax:330-456-4191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5295103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2064448Medicaid
OHCP23572Medicare ID - Type Unspecified