Provider Demographics
NPI:1548733199
Name:BYNUM, CLAUDE WILLIE
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:WILLIE
Last Name:BYNUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BUNCHE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-4221
Mailing Address - Country:US
Mailing Address - Phone:757-966-5865
Mailing Address - Fax:757-966-5865
Practice Address - Street 1:401 BUNCHE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-4221
Practice Address - Country:US
Practice Address - Phone:757-966-5865
Practice Address - Fax:757-966-5865
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist