Provider Demographics
NPI:1295859163
Name:DURHAM, CONNIE LUNNEN (MS)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LUNNEN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:LUNNEN
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:107 COMMERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5027
Mailing Address - Country:US
Mailing Address - Phone:252-355-2768
Mailing Address - Fax:
Practice Address - Street 1:326 RIVER BANK LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7327
Practice Address - Country:US
Practice Address - Phone:252-355-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical