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General NPI Number Information
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NPI Number | 1174195945
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Entity Type | Individual
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Provider Name | CHANNING M BUGBEE MA
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Gender | Female
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 16717 US HIGHWAY 17
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City | HAMPSTEAD
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State | NC
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Zip | 28443-3696
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Country | US
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Telephone | 910-599-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 708 SQUIRE LN
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City | WILMINGTON
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State | NC
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Zip | 28411-8346
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Country | US
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Telephone | 910-264-6801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-53905
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NC
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