Provider Demographics
NPI:1619921764
Name:WHITLOCK, LINDA JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 2ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3995
Mailing Address - Country:US
Mailing Address - Phone:910-251-2106
Mailing Address - Fax:910-251-7859
Practice Address - Street 1:311 N 2ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3995
Practice Address - Country:US
Practice Address - Phone:910-251-2106
Practice Address - Fax:910-251-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003141Medicaid
NC6003141Medicaid