Provider Demographics
NPI:1235582206
Name:SUNDANCE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:SUNDANCE CONSULTANTS, INC.
Other - Org Name:SUNDANCE FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:910-470-1816
Mailing Address - Street 1:360 ROCKY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-8202
Mailing Address - Country:US
Mailing Address - Phone:910-470-1816
Mailing Address - Fax:336-537-4203
Practice Address - Street 1:360 ROCKY TRAIL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-8202
Practice Address - Country:US
Practice Address - Phone:910-470-1816
Practice Address - Fax:336-537-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC656251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health