Provider Demographics
NPI:1346397825
Name:BUNCH, GLENN E JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:E
Last Name:BUNCH
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-0323
Mailing Address - Country:US
Mailing Address - Phone:252-747-8136
Mailing Address - Fax:
Practice Address - Street 1:1001 HARDEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-0000
Practice Address - Country:US
Practice Address - Phone:252-527-6400
Practice Address - Fax:252-527-4303
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106243Medicaid
NC2871981Medicare ID - Type Unspecified