Provider Demographics
NPI:1689190985
Name:ROYSTER, LINDA RENEE (LPCA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RENEE
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404B OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8874
Mailing Address - Country:US
Mailing Address - Phone:919-594-5220
Mailing Address - Fax:
Practice Address - Street 1:8378 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5082
Practice Address - Country:US
Practice Address - Phone:919-594-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health