Provider Demographics
NPI:1447083159
Name:BUNCH, GRAYCE LAKE (LCSW-A)
Entity type:Individual
Prefix:
First Name:GRAYCE
Middle Name:LAKE
Last Name:BUNCH
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4952
Mailing Address - Country:US
Mailing Address - Phone:252-644-7016
Mailing Address - Fax:
Practice Address - Street 1:115 ADAMS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1307
Practice Address - Country:US
Practice Address - Phone:252-741-3413
Practice Address - Fax:252-214-6662
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical