Provider Demographics
NPI:1780446807
Name:DEJONGE, AUNDREA
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:
Last Name:DEJONGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 LONGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7890
Mailing Address - Country:US
Mailing Address - Phone:980-397-2519
Mailing Address - Fax:
Practice Address - Street 1:250 N TRADE ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9449
Practice Address - Country:US
Practice Address - Phone:980-397-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health