Provider Demographics
NPI:1528517489
Name:DYER, PAULINE LUNDGREN (LISW-CP)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:LUNDGREN
Last Name:DYER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:DAVIS
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5698
Mailing Address - Fax:
Practice Address - Street 1:333 GASHES CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9405
Practice Address - Country:US
Practice Address - Phone:828-650-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical