Provider Demographics
NPI:1154674562
Name:DUNAHOO PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DUNAHOO PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNAHOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-219-3555
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-219-3555
Mailing Address - Fax:410-219-2666
Practice Address - Street 1:540 RIVERSIDE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5352
Practice Address - Country:US
Practice Address - Phone:410-219-3555
Practice Address - Fax:410-219-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383SMedicare UPIN