Provider Demographics
NPI:1831122522
Name:DLIN, EDITH DEBORAH (MSW)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:DEBORAH
Last Name:DLIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 RIVER RD
Mailing Address - Street 2:NA
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4323
Mailing Address - Country:US
Mailing Address - Phone:318-869-2400
Mailing Address - Fax:
Practice Address - Street 1:5705 RIVER RD
Practice Address - Street 2:NA
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4323
Practice Address - Country:US
Practice Address - Phone:318-869-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health