Provider Demographics
NPI:1043598394
Name:LUNSFORD, KENNY DUANE (CADCII,ICADC)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:DUANE
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:CADCII,ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 DE MILLE RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-6648
Mailing Address - Country:US
Mailing Address - Phone:530-828-3640
Mailing Address - Fax:
Practice Address - Street 1:2195 DE MILLE RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-6648
Practice Address - Country:US
Practice Address - Phone:530-828-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA021940216101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty