Basic Information
| Provider Information | |||||||||
| NPI: | 1528232022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYES | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 TOWNSEND CIR | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239032751 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 SHUGART RD | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705100 | ||||||||
| FaxNumber: | 7062705066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 12/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000743 | TN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CSW004644 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.