Provider Demographics
NPI:1053738716
Name:SMITH, LINDA WALTON (LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:WALTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SEMINARY
Mailing Address - State:MS
Mailing Address - Zip Code:39479-4367
Mailing Address - Country:US
Mailing Address - Phone:601-517-6770
Mailing Address - Fax:
Practice Address - Street 1:434 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-4367
Practice Address - Country:US
Practice Address - Phone:601-517-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional