Provider Demographics
NPI:1972763589
Name:MORTENSON, LINDA HOLLOWAY (MS, MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:HOLLOWAY
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:MS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5811
Mailing Address - Country:US
Mailing Address - Phone:336-275-9999
Mailing Address - Fax:
Practice Address - Street 1:2017 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5811
Practice Address - Country:US
Practice Address - Phone:336-275-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3143101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor