Provider Demographics
NPI:1801203070
Name:BUNNER, ABIDAH (BA)
Entity Type:Individual
Prefix:MRS
First Name:ABIDAH
Middle Name:
Last Name:BUNNER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BAYONET CIR
Mailing Address - Street 2:MARINA, CA 93933
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4600
Mailing Address - Country:US
Mailing Address - Phone:831-384-7251
Mailing Address - Fax:
Practice Address - Street 1:617 BAYONET CIR
Practice Address - Street 2:MARINA, CA 93933
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-4600
Practice Address - Country:US
Practice Address - Phone:831-384-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health