Provider Demographics
NPI:1013497437
Name:BOX, LINDA LOUISE (CDP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOUISE
Last Name:BOX
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 WESTGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2567
Mailing Address - Country:US
Mailing Address - Phone:253-503-0226
Mailing Address - Fax:
Practice Address - Street 1:5929 WESTGATE BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2567
Practice Address - Country:US
Practice Address - Phone:253-503-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60560378101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)