Provider Demographics
NPI:1780724997
Name:BUNDY, VICKIE B (LMHC)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:B
Last Name:BUNDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 REDWOOD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3836
Mailing Address - Country:US
Mailing Address - Phone:276-794-1043
Mailing Address - Fax:813-612-9373
Practice Address - Street 1:1616 REDWOOD ST APT 4
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3836
Practice Address - Country:US
Practice Address - Phone:276-794-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional