Healthcare Provider Details

I. General information

NPI: 1205998291
Provider Name (Legal Business Name): LINDAN KYLE BSW,CMC,QMRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1853 ROBINHILL CT
TUCKER GA
30084-7018
US

IV. Provider business mailing address

1853 ROBINHILL CT
TUCKER GA
30084-7018
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-6677
  • Fax: 770-918-6686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: