Basic Information
| Provider Information | |||||||||
| NPI: | 1912065079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | LICSW SOCIAL WORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | WOMACK ARMY MEDICAL CTR | ||||||||
| Address2: | 2817 REILLY ROAD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078973 | ||||||||
| FaxNumber: | 9109076571 | ||||||||
| Practice Location | |||||||||
| Address1: | WOMACK ARMY MEDICAL CTR | ||||||||
| Address2: | 2817 REILLY ROAD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078973 | ||||||||
| FaxNumber: | 9109076571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | DP00938749 | WV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.