Provider Demographics
NPI:1063787638
Name:BUSHMAN-DELEON, DARA ROBYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:ROBYN
Last Name:BUSHMAN-DELEON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WHITE ASH DR EAST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-5003
Mailing Address - Country:US
Mailing Address - Phone:954-296-5692
Mailing Address - Fax:
Practice Address - Street 1:128 WHITE ASH DR EAST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5003
Practice Address - Country:US
Practice Address - Phone:954-296-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist