Provider Demographics
NPI:1548879091
Name:WEAVER, LINDA ANN (MA, CMHC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MOCHA CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5341
Mailing Address - Country:US
Mailing Address - Phone:941-661-7267
Mailing Address - Fax:
Practice Address - Street 1:12811 KENWOOD LN STE 202-213
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5667
Practice Address - Country:US
Practice Address - Phone:239-537-9646
Practice Address - Fax:239-236-0866
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health