Provider Demographics
NPI:1801347794
Name:DUNLEAVY, ANDREW JONATHAN (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JONATHAN
Last Name:DUNLEAVY
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:JONATHAN
Other - Last Name:GOSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 WATER LILY CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6016
Mailing Address - Country:US
Mailing Address - Phone:480-228-5712
Mailing Address - Fax:
Practice Address - Street 1:4035 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3276
Practice Address - Country:US
Practice Address - Phone:336-747-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0109191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical