Provider Demographics
NPI:1700128881
Name:WATKINS, LUNDAY TALLEY (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:LUNDAY
Middle Name:TALLEY
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ROOKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2293
Mailing Address - Country:US
Mailing Address - Phone:919-345-2996
Mailing Address - Fax:
Practice Address - Street 1:509 ROOKWOOD CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2293
Practice Address - Country:US
Practice Address - Phone:919-345-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0066231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical