Healthcare Provider Details

I. General information

NPI: 1083216980
Provider Name (Legal Business Name): LINDA MARIE PEACE-BUIE NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA PEACE LPC

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/06/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 HARDING BLVD. STE. 143
BATON ROUGE LA
70811
US

IV. Provider business mailing address

PO BOX 74675
BATON ROUGE LA
70874-4675
US

V. Phone/Fax

Practice location:
  • Phone: 225-572-9622
  • Fax:
Mailing address:
  • Phone: 225-572-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1536
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: