Doctor Name: | MICHELLE BUNDRUM |
NPI Number: | 1043679194 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | ISW 10343 |
Business Practice Address: | 517 Deltona Blvd Ste A Deltona, FL - 327258016 |
Business Phone Number: | 4077709291 |
Business Fax Number: | |
Mailing Address: | 517 Deltona Blvd Ste A, DELTONA |
State: | FL |
Postal Code: | 327258016 |
Phone Number: | 4077709291 |
Fax Number: | |
NPI Enumeration Date: | 02/17/2016 |
NPI Last Update Date: | 02/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW 10343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |