Provider Demographics
NPI:1083385819
Name:BUNN, HERMAN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:BUNN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CROOKED BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-8001
Mailing Address - Country:US
Mailing Address - Phone:706-782-3671
Mailing Address - Fax:706-782-3671
Practice Address - Street 1:42 CROOKED BRANCH DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-8001
Practice Address - Country:US
Practice Address - Phone:706-782-3671
Practice Address - Fax:706-782-3671
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health