Provider Demographics
NPI:1164812442
Name:LUND, CARRYN (LMSW)
Entity Type:Individual
Prefix:
First Name:CARRYN
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 1ST ST
Mailing Address - Street 2:#314
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1395
Mailing Address - Country:US
Mailing Address - Phone:507-421-5235
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST
Practice Address - Street 2:SUITE 408
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:507-421-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010939401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical