Healthcare Provider Details

I. General information

NPI: 1174581136
Provider Name (Legal Business Name): LINDA DORMAN MSW, LMSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 BIRCH CREEK DR
WILMINGTON NC
28403-4271
US

IV. Provider business mailing address

1008 BIRCH CREEK DR
WILMINGTON NC
28403-4271
US

V. Phone/Fax

Practice location:
  • Phone: 810-772-3329
  • Fax:
Mailing address:
  • Phone: 810-772-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3108
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-01428
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008367
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: