Provider Demographics
NPI:1174331490
Name:FUNDERBURK, SYDNEY (LPC-A)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:FUNDERBURK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-A
Mailing Address - Street 1:211 HIGHWAY 651
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1815
Practice Address - Country:US
Practice Address - Phone:864-884-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty