Provider Demographics
NPI:1629198080
Name:LEA, LINDA F
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:F
Last Name:LEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W MONTCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5829
Mailing Address - Country:US
Mailing Address - Phone:336-691-0056
Mailing Address - Fax:
Practice Address - Street 1:406 W MONTCASTLE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5829
Practice Address - Country:US
Practice Address - Phone:336-691-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker