Provider Demographics
NPI:1053582957
Name:DUNHAM, CAROL J (M A, L S W)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:M A, L S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 GRANDVIEW DR STE 211
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2726
Mailing Address - Country:US
Mailing Address - Phone:859-344-8430
Mailing Address - Fax:859-344-8240
Practice Address - Street 1:211 GRANDVIEW DR STE 211
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2726
Practice Address - Country:US
Practice Address - Phone:859-344-8430
Practice Address - Fax:859-344-8240
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0022378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker