Provider Demographics
NPI:1760527204
Name:AYCOCK, LINDA C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:C
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 7 LKS W
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9339
Mailing Address - Country:US
Mailing Address - Phone:910-673-1167
Mailing Address - Fax:910-944-2175
Practice Address - Street 1:604 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2202
Practice Address - Country:US
Practice Address - Phone:910-944-2102
Practice Address - Fax:910-944-2175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102670Medicaid