Provider Demographics
NPI:1821037540
Name:KILLIAN, LINDA HALL (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:HALL
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:960 CORPORATE DRIVE, 401
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-0772
Mailing Address - Country:US
Mailing Address - Phone:919-732-3504
Mailing Address - Fax:919-732-3557
Practice Address - Street 1:960 CORPORATE DR STE 401
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8560
Practice Address - Country:US
Practice Address - Phone:919-732-3504
Practice Address - Fax:919-732-3557
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367101YA0400X
NCC0020751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002362Medicaid