Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPC 504 | OK |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ICADC 3978 | |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LADC 425 | OK |
NPI | 1013073352 |
---|---|
Provider Name | Ms. Linda Marshall Moffatt |
First Address | Edmond, OK 73013-1116 |
Second Address | Oklahoma City, OK 73116-7030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 01/07/2014 |