MEDICARE: BRITTANY SUNDBLOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1225861909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITTANY SUNDBLOM

Provider Business Mailing Address
First Line	:	PO BOX 633
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-0633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 N FAYETTEVILLE ST STE I
Second Line	:
City	:	LIBERTY
State	:	NC
Zip	:	27298-3203
Country	:	US
Telephone Number	:	860-866-6228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTANY SUNDBLOM
Credential	:
Telephone Number	:	336-539-1623

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	01/08/2025

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Directions to “BRITTANY SUNDBLOM ” Practice Location

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