Provider Demographics
NPI:1225364706
Name:GAUL-BUNCH, SHELON VANESSA (MSW)
Entity Type:Individual
Prefix:
First Name:SHELON
Middle Name:VANESSA
Last Name:GAUL-BUNCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 MIRANDA DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-5674
Mailing Address - Country:US
Mailing Address - Phone:910-551-5210
Mailing Address - Fax:
Practice Address - Street 1:4821 MIRANDA DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-5674
Practice Address - Country:US
Practice Address - Phone:910-551-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP005232OtherPROVISIONAL LICENSED CLINICAL SOCAL WORKER