Provider Demographics
NPI:1396838058
Name:BUNDICK, WILLIAM THOMAS JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:BUNDICK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8216 CREEDMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1391
Mailing Address - Country:US
Mailing Address - Phone:919-870-0264
Mailing Address - Fax:866-777-4638
Practice Address - Street 1:8216 CREEDMOOR RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1391
Practice Address - Country:US
Practice Address - Phone:919-870-0264
Practice Address - Fax:866-777-4638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000626Medicaid
NC2492774Medicare ID - Type Unspecified