Provider Demographics
NPI:1609190081
Name:DUNHAM, ANNE TRIPP (MA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:TRIPP
Last Name:DUNHAM
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:PO BOX I
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-0256
Mailing Address - Country:US
Mailing Address - Phone:863-206-2692
Mailing Address - Fax:847-589-1090
Practice Address - Street 1:808 PARK PL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4152
Practice Address - Country:US
Practice Address - Phone:863-206-2692
Practice Address - Fax:847-589-1090
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004787101YA0400X, 101YP2500X
FLMH10121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health