Healthcare Provider Details

I. General information

NPI: 1134489636
Provider Name (Legal Business Name): LINDA KILLIAN, LCSW, LCAS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CORPORATE DR STE 401
HILLSBOROUGH NC
27278-8560
US

IV. Provider business mailing address

PO BOX 772 960 CORPORATE DRIVE, SUITE 401
HILLSBOROUGH NC
27278-0772
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-3504
  • Fax: 919-732-3557
Mailing address:
  • Phone: 919-732-3504
  • Fax: 919-732-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberC002075
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberC002075
License Number StateNC

VIII. Authorized Official

Name: LINDA HALL KILLIAN
Title or Position: OWNER
Credential: LCSW, LCAS
Phone: 919-732-3504