person
Mary Alisa Bullock, LPCA,LCASA,NCC
Addiction (Substance Use Disorder) Counselor in Lexington, North Carolina
NPI 1902458037

Mary Alisa Bullock is an Addiction (Substance Use Disorder) Counselor based in Concord, NC and is specialized in Addiction (Substance Use Disorder). Mary Alisa Bullock practices in Lexington, NC and has the professional credentials of LPCA,LCASA,NCC. The NPI Number for Mary Alisa Bullock is 1902458037 and holds a License No. 25659 (North Carolina).

The current practice location address for Mary Alisa Bullock is 1104A S Main St, Lexington, NC and can be reached out via phone at 336-242-2450.

Location: 1104A S Main St, Lexington, NC, 28025-1833
person
Provider Profile Details
NPI Number
1902458037
Provider Name
Mary Alisa Bullock
Credential
LPCA,LCASA,NCC
Provider Entity Type
Individual
Gender
Female
Address
1104A S Main St, Lexington, NC, 28025-1833
Phone Number
336-242-2450
Fax Number
Provider Enumeration Date
07/09/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
101YP2500X 01 NC STATE OF NC
101YA0400X 01 NC STATE OF NC
institution
Provider Business Practice Location Address Details
Address
1104A S Main St
City
State
Zip
27292-3134
Phone Number
336-242-2450
Fax Number
person
Provider Business Mailing Address Details
Address
1104A S Main St
City
State
Zip
27292-3134
Phone Number
336-242-2450
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
14910 (North Carolina)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
A14910 (North Carolina)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
25659 (North Carolina)
Definition
Definition to come...
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