Provider Demographics
NPI:1396282430
Name:BUNN, JENNIFER (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-2429
Mailing Address - Country:US
Mailing Address - Phone:434-294-7486
Mailing Address - Fax:
Practice Address - Street 1:609 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1607
Practice Address - Country:US
Practice Address - Phone:434-294-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional