Individual
MR. BRUCE EADS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1100 NAVAHO DR, SUITE 123, RALEIGH, NC 27609-7319
(919) 412-7069
(919) 832-4708
Mailing address
2359 DERBY DR, RALEIGH, NC 27610-1741
(919) 412-7069
(919) 832-4708
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004096
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135E7
BCBSNC
NC
05
—
6003683
—
NC
Enumeration date
04/14/2006
Last updated
07/08/2007
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