Healthcare Provider Details

I. General information

NPI: 1194890657
Provider Name (Legal Business Name): LINDA O WORKMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GLASS DRIVE
CROSS LANES WV
25313
US

IV. Provider business mailing address

202 GLASS DRIVE
CROSS LANES WV
25313
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-7230
  • Fax: 304-776-7247
Mailing address:
  • Phone: 304-776-7230
  • Fax: 304-776-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number273
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: