Provider Demographics
NPI:1669693537
Name:LUNDQUIST, LORRIE L (LCSW, M ED)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:L
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LCSW, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-4835
Mailing Address - Country:US
Mailing Address - Phone:907-350-3757
Mailing Address - Fax:
Practice Address - Street 1:1720 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4835
Practice Address - Country:US
Practice Address - Phone:907-350-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN67201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6578Medicaid