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General NPI Number Information
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NPI Number | 1205481991
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Entity Type | Organization
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Legal Business Name | NAZA BUNGU LLC
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 840 BOSTON POST RD
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City | WEST HAVEN
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State | CT
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Zip | 06516-1847
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Country | US
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Telephone | 203-445-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 840 BOSTON POST RD STE 5
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City | WEST HAVEN
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State | CT
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Zip | 06516-1848
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Country | US
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Telephone | 203-445-6593
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/ OWNER
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Name | NAZA BUNGU
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Credential |
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Telephone | 203-848-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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