MARK VINCENT SUNDSTROM (NPI# 1548473903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548473903 |
| Entity Type | Individual |
| Full Name | MARK VINCENT SUNDSTROM |
| Credential | M.S.,LICSW |
| Practice Address |
209 W Maple Ave Fayetteville WV 25840-1413 |
| Practice Telephone | 3045742100 |
| Practice Fax Number | 3045742151 |
| Mailing Telephone | 3045742100 |
| Mailing Fax Number | 3045742151 |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
DP00450472 | WV | Behavioral Health & Social Service Providers |
| Street Address |
209 W MAPLE AVE |
| City | FAYETTEVILLE |
| State | WV |
| Zip Code | 25840-1413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134279581 | Stephanie Jill Daniel | Psychologist | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2007-01-10 |
| 1023617081 | Cynthia Ann Bail | Case Manager/Care Coordinator | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2020-10-21 |
| 1518581404 | Heather Renee Collins | Social Worker | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2020-06-05 |
| 1962912410 | Wendy Pruett Young | Counselor | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2017-10-10 |
| 1134552888 | Rebecca Rae Stone | Psychologist | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2013-08-16 |
| 1750594115 | Philip E Sundstrom | Psychologist | 209 W Maple Ave, Fayetteville, WV 25840-1413 | 2007-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447766639 | Nancy Carol Myles | Technician | 171 Wood Rd, Fayetteville, WV 25840 | 2017-12-26 |
| 1598933954 | Kembra Anne Crist | Registered Nurse | 111 Fayette Avenue, Fayette County Boe, Fayetteville, WV 25840 | 2008-02-19 |
| 1003004854 | Edward Lee Winter | Psychologist | 111 Fayette Ave., Fayette County Schools, Fayetteville, WV 25840 | 2007-10-05 |
| 1811109432 | Anita Louise Swanson | Physical Therapist | 111 Fayette Ave, Fayetteville, WV 25840 | 2007-05-04 |
| 1003964008 | Krista L Copenhaver-mackowiak | Nurse Anesthetist, Certified Registered | 613 Crooked Run Rd, Fayetteville, WV 25840 | 2007-01-08 |
| 1922171024 | Carl Arthur Hansen | Dentist | 215 North Court St, Fayetteville, WV 25840 | 2006-11-16 |
| 1932202447 | Appalachian Regional Healthcare | Clinic/Center | 436 Elizabeth Way, Fayetteville, WV 25840 | 2006-09-07 |
| 1154424810 | West Virginia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 72 Whitewater Ave, Fayetteville, WV 25840 | 2006-09-07 |
| 1447241310 | Karen L. Pettry-hultman | Family Medicine | Rr 3 Box 9, Fayetteville, WV 25840 | 2005-10-31 |
| 1598125577 | Jeanne Black | Registered Nurse | 111 Fayette Avenue, Fayette County Schools, Fayetteville, WV 25840 | 2016-03-03 |
| Find all providers in zip 25840 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
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| 1861004996 | Roderick Eugene Brown Jr. | Social Worker | 2014 Litho Pl Ste 200, Fayetteville, NC 28304-2518 | 2020-08-19 |
| 1427667278 | Valerie Russell | Social Worker | 6209 Lakehaven Dr, Fayetteville, NC 28304-0610 | 2020-07-28 |
| 1942822671 | Alexis Oneal Vestal | Social Worker | 723 Athens Ave, Fayetteville, NC 28301-4800 | 2020-05-15 |
| 1346862281 | Heather Marie Sroka | Social Worker | 690 N Reilly Rd # F, Fayetteville, NC 28303-5724 | 2020-05-14 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1730716887 | Denise Rodriguez | Social Worker | 2885 N Brookbury Xing, Fayetteville, AR 72703-4377 | 2020-03-26 |
| 1982239877 | Alicia Story | Social Worker | 3035 Boone Trail Ext, Fayetteville, NC 28304-3992 | 2020-03-11 |
| 1053959619 | Benlyd Colon | Social Worker | 2940 Breezewood Ave Ste 101-201, Fayetteville, NC 28303-5520 | 2019-12-13 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 25840 |
Please comment or provide details below to improve the information on MARK VINCENT SUNDSTROM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.