MEDICARE: THERESA BUNT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	20407	FL
2	101YP2500X	Professional Counselor	10939	SC

General Provider Information

NPI Number	:	1871158410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA BUNT LPC

Provider Business Mailing Address
First Line	:	126 VERANDA DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-6267
Country	:	US
Telephone Number	:	410-903-9883
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 VERANDA DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-6267
Country	:	US
Telephone Number	:	410-903-9883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	01/15/2026

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Directions to “ THERESA BUNT LPC” Practice Location

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