Individual
ALICIA MARIE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWA, LCASA
Contact information
Practice address
284 EXECUTIVE PARK DR, SUITE 100, CONCORD, NC 28025-1831
(704) 939-1100
(704) 939-1173
Mailing address
10338 SAMUELS WAY DR, HUNTERSVILLE, NC 28078-7629
(252) 799-7071
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
2976A
NC
1041C0700X
Clinical Social Worker
Primary
P007477
NC
Other
Enumeration date
08/07/2012
Last updated
08/12/2015
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