Provider Demographics
NPI:1285941724
Name:BUNN, SHELLEY JAN (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JAN
Last Name:BUNN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PINER RD.
Mailing Address - Street 2:SUITE A #552
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409
Mailing Address - Country:US
Mailing Address - Phone:360-903-5895
Mailing Address - Fax:
Practice Address - Street 1:609 PINER RD.
Practice Address - Street 2:SUITE A #552
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409
Practice Address - Country:US
Practice Address - Phone:360-903-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61389889101YM0800X
171M00000X
NCA18628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator