Provider Demographics
NPI:1386351484
Name:DUNN, RACHEL LYDIA (LGSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYDIA
Last Name:DUNN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CADET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2005
Mailing Address - Country:US
Mailing Address - Phone:304-290-8962
Mailing Address - Fax:
Practice Address - Street 1:105 N WEDGE ST STE 3
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-2023
Practice Address - Country:US
Practice Address - Phone:304-241-1766
Practice Address - Fax:855-898-5805
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944453104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker