Provider Demographics
NPI:1427532357
Name:LUNORE, SHAUNDRA W (CDPT)
Entity type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:W
Last Name:LUNORE
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 HARBOR HILL DR # B-216
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8953
Mailing Address - Country:US
Mailing Address - Phone:253-225-1200
Mailing Address - Fax:
Practice Address - Street 1:5122 OLYMPIC DR NW STE A105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1768
Practice Address - Country:US
Practice Address - Phone:253-851-2552
Practice Address - Fax:253-858-8506
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60633779101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)