Provider Demographics
NPI:1174716492
Name:BUNTING, VANESSA LEE (LCMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEE
Last Name:BUNTING
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PICHMOND PATH
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6602
Mailing Address - Country:US
Mailing Address - Phone:770-255-8947
Mailing Address - Fax:
Practice Address - Street 1:403 PICHMOND PATH
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-6602
Practice Address - Country:US
Practice Address - Phone:770-255-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist