Provider Demographics
NPI:1205327400
Name:BUNCH, CHRISTIE LYNN (LSW,LICDC)
Entity type:Individual
Prefix:MISS
First Name:CHRISTIE
Middle Name:LYNN
Last Name:BUNCH
Suffix:
Gender:F
Credentials:LSW,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 BABBITT RD APT A202
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2576
Mailing Address - Country:US
Mailing Address - Phone:330-968-9233
Mailing Address - Fax:
Practice Address - Street 1:1214 POMONA RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2458
Practice Address - Country:US
Practice Address - Phone:330-968-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162177101YA0400X
OH1802317104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)