Basic Information
Provider Information
NPI: 1902265283
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DULANEY
FirstName: ERYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 284 EXECUTIVE PARK DR
Address2: STE 100
City: CONCORD
State: NC
PostalCode: 280251894
CountryCode: US
TelephoneNumber: 7049391100
FaxNumber: 7049391173
Practice Location
Address1: 220 E 1ST AVENUE EXT
Address2: SUITE 10
City: LEXINGTON
State: NC
PostalCode: 272923368
CountryCode: US
TelephoneNumber: 3362422450
FaxNumber: 3362499920
Other Information
ProviderEnumerationDate: 02/16/2016
LastUpdateDate: 02/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP010246NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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