Provider Demographics
NPI:1043299068
Name:UNGETHEIM, MARY DOUGLAS (MA LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DOUGLAS
Last Name:UNGETHEIM
Suffix:
Gender:F
Credentials:MA LMFT
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Mailing Address - Street 1:3000 BETHESDA PL
Mailing Address - Street 2:OPTIONS OF WINSTON SALEM SUITE 103
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3331
Mailing Address - Country:US
Mailing Address - Phone:336-768-9768
Mailing Address - Fax:336-768-9557
Practice Address - Street 1:3000 BETHESDA PL
Practice Address - Street 2:OPTIONS OF WINSTON SALEM SUITE 103
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3331
Practice Address - Country:US
Practice Address - Phone:336-768-9768
Practice Address - Fax:336-768-9557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist