Provider Demographics
NPI:1497586549
Name:BUNTON, WILLIAM LAMAR SR (MA, RIC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LAMAR
Last Name:BUNTON
Suffix:SR
Gender:M
Credentials:MA, RIC
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:757-275-5240
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3300
Practice Address - Country:US
Practice Address - Phone:757-977-8455
Practice Address - Fax:757-765-6450
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health