Provider Demographics
NPI:1154587228
Name:BULLOCK, GEOFFREY EARLE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:EARLE
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-0958
Mailing Address - Country:US
Mailing Address - Phone:828-686-9601
Mailing Address - Fax:828-686-9601
Practice Address - Street 1:16 OVERBROOK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2317
Practice Address - Country:US
Practice Address - Phone:828-686-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical