Provider Demographics
NPI:1609988906
Name:GOLUMBIA, LINDA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:GOLUMBIA
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 1:29260 FRANKLIN RD
Mailing Address - Street 2:#114
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-262-1234
Mailing Address - Fax:248-262-8595
Practice Address - Street 1:29260 FRANKLIN RD
Practice Address - Street 2:#114
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-262-1234
Practice Address - Fax:248-262-8595
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F33035OtherBLUE CROSS BLUE SHIELD
099019OtherMHN
099019OtherMHN
S12205Medicare UPIN