Provider Demographics
NPI:1588655054
Name:NEAL, LINDA L (LIC SW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:NEAL
Suffix:
Gender:F
Credentials:LIC SW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC SW
Mailing Address - Street 1:645 KANAWHA AVE
Mailing Address - Street 2:RAINELLE MEDICAL CENTER INC
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1013
Mailing Address - Country:US
Mailing Address - Phone:304-438-6188
Mailing Address - Fax:304-438-6819
Practice Address - Street 1:645 KANAWHA AVE
Practice Address - Street 2:RAINELLE MEDICAL CENTER INC
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1013
Practice Address - Country:US
Practice Address - Phone:304-438-6188
Practice Address - Fax:304-438-6819
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009421881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003003Medicaid
WVSW36841Medicare Oscar/Certification