Provider Demographics
NPI:1073119988
Name:SAN JUAN-DUNFORD, GERALDINE (MA LPC)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:SAN JUAN-DUNFORD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W WASHINGTON AVE STE 210B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2160
Mailing Address - Country:US
Mailing Address - Phone:517-227-6038
Mailing Address - Fax:517-962-5316
Practice Address - Street 1:300 W WASHINGTON AVE STE 210B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2160
Practice Address - Country:US
Practice Address - Phone:517-227-6038
Practice Address - Fax:517-962-5316
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional