Provider Demographics
NPI:1801217492
Name:WOOTTON, LINDA FAYE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:WOOTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5335
Mailing Address - Country:US
Mailing Address - Phone:707-391-7341
Mailing Address - Fax:
Practice Address - Street 1:564 S DORA ST
Practice Address - Street 2:SUITE B
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5486
Practice Address - Country:US
Practice Address - Phone:707-472-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health