Provider Demographics
NPI:1285007682
Name:LUNDY, CASSANDRA AIRE LASHON
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:AIRE LASHON
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ONTARIO CT
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-6723
Mailing Address - Country:US
Mailing Address - Phone:386-453-7035
Mailing Address - Fax:
Practice Address - Street 1:112 ONTARIO CT
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6723
Practice Address - Country:US
Practice Address - Phone:386-453-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL530-101-78-927-0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health