Provider Demographics
NPI:1679233225
Name:BUNTON, ANGEL MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARIE
Last Name:BUNTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 REPLICA LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5218
Mailing Address - Country:US
Mailing Address - Phone:757-553-2352
Mailing Address - Fax:
Practice Address - Street 1:800 NEWTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1265
Practice Address - Country:US
Practice Address - Phone:757-974-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040132901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical