Provider Demographics
NPI:1891808184
Name:PRYOR, LINDA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 LONG COVE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5879
Mailing Address - Country:US
Mailing Address - Phone:919-250-0399
Mailing Address - Fax:
Practice Address - Street 1:220 SWINBURNE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1834
Practice Address - Country:US
Practice Address - Phone:919-212-7571
Practice Address - Fax:919-212-7585
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003676Medicaid