Provider Demographics
NPI:1831129691
Name:CHARLES, LINDA SWANSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SWANSON
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S SIERRA AVE
Mailing Address - Street 2:#23
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2638
Mailing Address - Country:US
Mailing Address - Phone:858-481-6836
Mailing Address - Fax:
Practice Address - Street 1:707 S SIERRA AVE
Practice Address - Street 2:#23
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2638
Practice Address - Country:US
Practice Address - Phone:858-481-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA008506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPD0085060Medicaid
CACP8506Medicare ID - Type Unspecified
CAPD0085060Medicaid