Provider Demographics
NPI:1841289071
Name:DUNGAN, DEBORAH (LMHC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 KING ARTHUR CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1801
Mailing Address - Country:US
Mailing Address - Phone:904-347-3365
Mailing Address - Fax:904-797-9852
Practice Address - Street 1:1100 S PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6099
Practice Address - Country:US
Practice Address - Phone:904-824-7733
Practice Address - Fax:904-829-9768
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7696OtherBCBS
FL762875700Medicaid