Provider Demographics
NPI:1689247710
Name:DUNN, CORY (LMHP-R)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:DUNN
Suffix:
Gender:M
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GREENELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2021
Mailing Address - Country:US
Mailing Address - Phone:757-642-7306
Mailing Address - Fax:
Practice Address - Street 1:10 GREENELAND BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2021
Practice Address - Country:US
Practice Address - Phone:757-642-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704009058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0704009058Medicaid