Organization
INDEPENDENCE CHILD THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINDA BOURDON ED.D., LCP (DIRECTOR)
(757) 460-2057
Entity
Organization
Contact information
Practice address
4807A LAUDERDALE AVE, VIRGINIA BEACH, VA 23455-1364
(757) 460-2057
(757) 963-9020
Mailing address
PO BOX 55145, VIRGINIA BEACH, VA 23471-5145
(757) 460-2057
(757) 963-9020
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004468
VA
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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