Provider Demographics
NPI:1912363250
Name:SDUNEK, AUTUMN N (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:N
Last Name:SDUNEK
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:N
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3410 OLD LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4392
Mailing Address - Country:US
Mailing Address - Phone:517-657-2980
Mailing Address - Fax:517-993-5982
Practice Address - Street 1:3410 OLD LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4392
Practice Address - Country:US
Practice Address - Phone:517-657-2980
Practice Address - Fax:517-993-5982
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016346101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)