Provider Demographics
NPI:1831695865
Name:NOVAK, LINDA JOY
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOY
Last Name:NOVAK
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 1:27111 W 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2323
Mailing Address - Country:US
Mailing Address - Phone:734-646-2727
Mailing Address - Fax:
Practice Address - Street 1:950 SEVEN HILLS DR UNIT 122
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4306
Practice Address - Country:US
Practice Address - Phone:734-646-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181140282251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health