Provider Demographics
NPI:1770700817
Name:DEVINE, LINDA ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:DEVINE
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 1:5565 ANGEL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9113
Mailing Address - Country:US
Mailing Address - Phone:336-377-9449
Mailing Address - Fax:
Practice Address - Street 1:5565 ANGEL OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9113
Practice Address - Country:US
Practice Address - Phone:336-377-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional