Provider Demographics
NPI:1871158410
Name:BUNT, THERESA (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BUNT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:E
Other - Last Name:SIEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 VERANDA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6267
Mailing Address - Country:US
Mailing Address - Phone:410-903-9883
Mailing Address - Fax:
Practice Address - Street 1:651 SCHOLAR WAY STE 101
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-3052
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20407101YM0800X
SC10939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health