Provider Demographics
NPI:1336557123
Name:ANDERSON SUMRALL, LINDA (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ANDERSON SUMRALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SUMRALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOSO
Mailing Address - State:MS
Mailing Address - Zip Code:39480-5190
Mailing Address - Country:US
Mailing Address - Phone:601-270-8739
Mailing Address - Fax:
Practice Address - Street 1:141 SUMRALL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOSO
Practice Address - State:MS
Practice Address - Zip Code:39480-5190
Practice Address - Country:US
Practice Address - Phone:601-270-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional