Provider Demographics
NPI:1477952992
Name:POLLACK, LINDA JEAN (LPC, LISAC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:POLLACK
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 E CAMELBACK RD
Mailing Address - Street 2:SUITE K300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8301
Mailing Address - Country:US
Mailing Address - Phone:602-343-8232
Mailing Address - Fax:602-343-8233
Practice Address - Street 1:4250 E CAMELBACK RD
Practice Address - Street 2:SUITE K300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8301
Practice Address - Country:US
Practice Address - Phone:602-343-8232
Practice Address - Fax:602-343-8233
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10177101YA0400X
AZLPC-10720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)