Provider Demographics
NPI:1518379809
Name:LUNDEMO, CAROL JOY (MA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JOY
Last Name:LUNDEMO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4603
Mailing Address - Country:US
Mailing Address - Phone:206-235-8587
Mailing Address - Fax:
Practice Address - Street 1:1900 N 175TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5104
Practice Address - Country:US
Practice Address - Phone:206-235-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60459685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health