Provider Demographics
NPI:1184342172
Name:LUNDERGAN, RYAN AIDAN (LGPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:AIDAN
Last Name:LUNDERGAN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROGER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1442
Mailing Address - Country:US
Mailing Address - Phone:443-766-9018
Mailing Address - Fax:
Practice Address - Street 1:2057 PULASKI HWY STE 4
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3744
Practice Address - Country:US
Practice Address - Phone:443-877-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional