| Doctor Name: | DR. LINDA COOPER LACK |
| NPI Number: | 1043357064 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 1776 |
| Business Practice Address: | 1371 Wading Bird Lane Myrtle Beach, SC - 29577 |
| Business Phone Number: | 8434486516 |
| Business Fax Number: | |
| Mailing Address: | Po Box 70478, MYRTLE BEACH |
| State: | SC |
| Postal Code: | 295720026 |
| Phone Number: | 8436024284 |
| Fax Number: | 8434486516 |
| NPI Enumeration Date: | 01/31/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1776 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |