Provider Demographics
NPI:1881994507
Name:LUNDIN, MARILYN JOANNA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JOANNA
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 YELVERTON GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7583
Mailing Address - Country:US
Mailing Address - Phone:919-601-3762
Mailing Address - Fax:
Practice Address - Street 1:1516 YELVERTON GROVE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7583
Practice Address - Country:US
Practice Address - Phone:919-601-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health