Provider Demographics
NPI:1770564627
Name:SPALDING, LINDA S (MED)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:SPALDING
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 MARTIN LUTHER KING ST., N.
Mailing Address - Street 2:APT 8209
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:727-303-4518
Mailing Address - Fax:757-229-9626
Practice Address - Street 1:11850 MARTIN LUTHER KING ST., N.
Practice Address - Street 2:APT 8209
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-303-4518
Practice Address - Fax:757-229-9626
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor