Individual
RODERICK CONLEY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3104 MINTLEAF DRIVE, CHARLOTTE, NC 28269
(704) 519-8264
Mailing address
3104 MINTLEAF DR, CHARLOTTE, NC 28269-3069
(704) 589-1478
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/23/2008
Last updated
09/22/2022
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