Provider Demographics
NPI:1073692703
Name:MUNDELL, JAMES BEDFORD (MS LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BEDFORD
Last Name:MUNDELL
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-1030
Mailing Address - Country:US
Mailing Address - Phone:252-531-4166
Mailing Address - Fax:252-825-1818
Practice Address - Street 1:107 W. LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NC
Practice Address - Zip Code:27840
Practice Address - Country:US
Practice Address - Phone:252-531-4166
Practice Address - Fax:252-825-1818
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103296Medicaid
NC143T1OtherBLUE CROSS BLUE SHIELD
NC192251OtherMEDCOST