Provider Demographics
NPI:1104223973
Name:DUNLEVY, LISA CAROLYN (MAC, LAC, DIPL A)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROLYN
Last Name:DUNLEVY
Suffix:
Gender:F
Credentials:MAC, LAC, DIPL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SEA GULL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4145
Mailing Address - Country:US
Mailing Address - Phone:843-259-9889
Mailing Address - Fax:
Practice Address - Street 1:950 SEA GULL DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4145
Practice Address - Country:US
Practice Address - Phone:843-259-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist