Individual
ZACHARY LUNDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3115 SUNSET BLVD, WEST COLUMBIA, SC 29169-3425
(803) 791-3722
Mailing address
2580 LIN DO CT, SUMTER, SC 29150-1832
(803) 905-4427
(803) 905-4427
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-32744
SC
Other
Enumeration date
04/11/2018
Last updated
04/11/2018
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