Provider Demographics
NPI:1659326619
Name:GATCHEL, LINDA MARDELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARDELL
Last Name:GATCHEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W LEBANON ST
Mailing Address - Street 2:SUITE C & E
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2935
Mailing Address - Country:US
Mailing Address - Phone:336-716-0800
Mailing Address - Fax:336-716-0822
Practice Address - Street 1:131 W LEBANON ST
Practice Address - Street 2:SUITE C & E
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2935
Practice Address - Country:US
Practice Address - Phone:336-786-1922
Practice Address - Fax:336-786-1923
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013791041C0700X
NCC00013791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC001349Medicaid