Provider Demographics
NPI:1821701673
Name:LUNDY, RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CAITLYN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6017
Mailing Address - Country:US
Mailing Address - Phone:404-394-3848
Mailing Address - Fax:
Practice Address - Street 1:208 CAITLYN DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6017
Practice Address - Country:US
Practice Address - Phone:404-394-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical