Provider Demographics
NPI:1538230602
Name:MAXWELL, LINDA S (MA, LPA, CH)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA, LPA, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 EASTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-4756
Mailing Address - Country:US
Mailing Address - Phone:704-572-2201
Mailing Address - Fax:704-535-3751
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:STE 902
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-521-1117
Practice Address - Fax:704-521-2771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1943103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist