Provider Demographics
NPI:1679211403
Name:LORSUNG, ADISON MARIE
Entity type:Individual
Prefix:
First Name:ADISON
Middle Name:MARIE
Last Name:LORSUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6291 CAMBRIDGE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7944
Mailing Address - Country:US
Mailing Address - Phone:317-718-8436
Mailing Address - Fax:317-718-8438
Practice Address - Street 1:6291 CAMBRIDGE WAY STE 200
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-7944
Practice Address - Country:US
Practice Address - Phone:317-718-8436
Practice Address - Fax:317-718-8438
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005170A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health