Provider Demographics
NPI:1952798381
Name:BUMGARDNER, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BUMGARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 ENGLE RD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2223
Mailing Address - Country:US
Mailing Address - Phone:916-977-0949
Mailing Address - Fax:916-977-0423
Practice Address - Street 1:4741 ENGLE RD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2223
Practice Address - Country:US
Practice Address - Phone:916-977-0949
Practice Address - Fax:916-977-0423
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health