Provider Demographics
NPI:1811567977
Name:DUNLEAVY FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:DUNLEAVY FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNLEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, LMFT, ASDCS
Authorized Official - Phone:336-497-5271
Mailing Address - Street 1:950 GRAVES ST STE G
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3246
Mailing Address - Country:US
Mailing Address - Phone:336-497-5271
Mailing Address - Fax:336-360-6724
Practice Address - Street 1:950 GRAVES ST STE G
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3246
Practice Address - Country:US
Practice Address - Phone:336-497-5271
Practice Address - Fax:336-360-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1930OtherNC MFT LICENSURE BOARD
NC1386197002OtherNPI