=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841652427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EBONY DUNIGAN LLMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2016
-----------------------------------------------------
Last Update Date | 03/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2242 E MAPLE AVE #207
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-771-8948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2518 PROCTOR AVE
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48504-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-580-6513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 4101006683
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------