Provider Demographics
NPI:1093599300
Name:DUNBAR, MARIANN ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:ELIZABETH
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARIANN
Other - Middle Name:ELIZABETH
Other - Last Name:PANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3970 N OAKLAND AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2265
Mailing Address - Country:US
Mailing Address - Phone:414-241-1813
Mailing Address - Fax:
Practice Address - Street 1:3970 N OAKLAND AVE STE 504
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-241-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10567-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty