Provider Demographics
NPI:1912931502
Name:BOOTHE, LINDA JAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JAN
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1332
Mailing Address - Country:US
Mailing Address - Phone:252-747-8162
Mailing Address - Fax:
Practice Address - Street 1:313 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-2851
Practice Address - Country:US
Practice Address - Phone:252-745-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33491041C0700X
NCC0056191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical