Provider Demographics
NPI:1548931868
Name:TUNSTALL, JAMES HANEY IV
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HANEY
Last Name:TUNSTALL
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 MAR DON DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4624
Mailing Address - Country:US
Mailing Address - Phone:336-923-7426
Mailing Address - Fax:
Practice Address - Street 1:983 MAR DON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4624
Practice Address - Country:US
Practice Address - Phone:336-923-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17003101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty