Healthcare Provider Details

I. General information

NPI: 1841395803
Provider Name (Legal Business Name): LINDA ANN GALLAHER M.A., LPC, LLP, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY SUITE # 312
CLARKSTON MI
48346-2087
US

IV. Provider business mailing address

622 7TH ST
ROCHESTER MI
48307-1404
US

V. Phone/Fax

Practice location:
  • Phone: 248-922-2300
  • Fax:
Mailing address:
  • Phone: 248-650-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: