Provider Demographics
NPI:1528757655
Name:BUNCH, CHAUNTAY (CAC)
Entity type:Individual
Prefix:
First Name:CHAUNTAY
Middle Name:
Last Name:BUNCH
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 VILLAGE POND CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1161
Mailing Address - Country:US
Mailing Address - Phone:417-771-2559
Mailing Address - Fax:
Practice Address - Street 1:5734 VILLAGE POND CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1161
Practice Address - Country:US
Practice Address - Phone:417-771-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)