Provider Demographics
NPI:1790014454
Name:LUNCEFORD, CARRIE (LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LUNCEFORD
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 1:3603 PAESANOS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1270
Mailing Address - Country:US
Mailing Address - Phone:210-614-3011
Mailing Address - Fax:
Practice Address - Street 1:3603 PAESANOS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1270
Practice Address - Country:US
Practice Address - Phone:210-614-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional