Doctor Name: | MS. LINDA K MOFFATT |
NPI Number: | 1003831413 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180-001694 |
Business Practice Address: | 611 W Delmar Ave Alton, IL - 620024214 |
Business Phone Number: | 6187918006 |
Business Fax Number: | 6182436558 |
Mailing Address: | 611 W Delmar Ave, ALTON |
State: | IL |
Postal Code: | 620024214 |
Phone Number: | 6187918006 |
Fax Number: | 6182436558 |
NPI Enumeration Date: | 07/13/2006 |
NPI Last Update Date: | 01/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180-001694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |