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General NPI Number Information
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NPI Number | 1861990905
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Entity Type | Individual
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Provider Name | CEDRIC R DUNMORE LCDC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/28/2018
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Provider Practice Location Address
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Address Line | 821 GRAND AVENUE PKWY STE 108
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2197
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Country | US
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Telephone | 512-786-3384
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Fax | 512-551-2619
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Provider Business Mailing Address
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Address Line | PO BOX 2113
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City | PFLUGERVILLE
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State | TX
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Zip | 78691-2113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8987
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License Number State | TN
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