Provider Demographics
NPI:1265609267
Name:LINDA B. SHAMBLIN, PH. D., P. A.
Entity type:Organization
Organization Name:LINDA B. SHAMBLIN, PH. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-258-9399
Mailing Address - Street 1:144 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2337
Mailing Address - Country:US
Mailing Address - Phone:828-258-9399
Mailing Address - Fax:828-258-9495
Practice Address - Street 1:144 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2337
Practice Address - Country:US
Practice Address - Phone:828-258-9399
Practice Address - Fax:828-258-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000018Medicaid