Healthcare Provider Details

I. General information

NPI: 1649513607
Provider Name (Legal Business Name): LINDA MARIE ALDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA MARIE TORRES

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 THIRTEENTH AVENUE
LUCERNE CA
95458
US

IV. Provider business mailing address

P.O. BOX 1024 6302 THIRTEENTH AVENUE
LUCERNE CA
95458
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9101
  • Fax: 707-274-9102
Mailing address:
  • Phone: 707-274-9101
  • Fax: 707-274-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: