Provider Demographics
NPI:1619782687
Name:DUPERON, LORI ANNE (MFT INTERN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:DUPERON
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-1747
Mailing Address - Country:US
Mailing Address - Phone:310-245-3497
Mailing Address - Fax:
Practice Address - Street 1:103 GORDON ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-1747
Practice Address - Country:US
Practice Address - Phone:310-245-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program