Provider Demographics
NPI:1467597641
Name:LUNG, DEBORAH S (LPC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:LUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-5708
Mailing Address - Country:US
Mailing Address - Phone:803-431-0037
Mailing Address - Fax:
Practice Address - Street 1:4701 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3217
Practice Address - Country:US
Practice Address - Phone:803-431-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002600101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945166Medicaid
VA400231OtherANTHEM BLUE CROSS BLUE SH