Provider Demographics
NPI:1104081140
Name:BUNCH, JOSEPH HENRY (MA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:BUNCH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S OAKUM ST
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-2048
Mailing Address - Country:US
Mailing Address - Phone:252-333-5583
Mailing Address - Fax:
Practice Address - Street 1:213 S OAKUM ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-2048
Practice Address - Country:US
Practice Address - Phone:252-333-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1539103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service