Healthcare Provider Details

I. General information

NPI: 1003539537
Provider Name (Legal Business Name): CHRISTOPHER AARON BUMGARNER LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WILLOW LN
NORTH WILKESBORO NC
28659-3551
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 336-667-5151
  • Fax: 336-838-3133
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA18078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: