Provider Demographics
NPI:1518472778
Name:LUNSFORD, REBECCA ANNETTE (BS EARLY CHILDHOOD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNETTE
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:BS EARLY CHILDHOOD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS EARLY CHILDHOOD
Mailing Address - Street 1:165 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705
Mailing Address - Country:US
Mailing Address - Phone:706-581-8985
Mailing Address - Fax:
Practice Address - Street 1:165 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705
Practice Address - Country:US
Practice Address - Phone:706-581-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator