Provider Demographics
NPI:1366919425
Name:BISHOP, NICY (LMFT)
Entity type:Individual
Prefix:MRS
First Name:NICY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BLUE PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9176
Mailing Address - Country:US
Mailing Address - Phone:254-630-0401
Mailing Address - Fax:
Practice Address - Street 1:901 ARSENAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5478
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:910-491-0833
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12085A106H00000X
NC2302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12085AOtherNC MARRIAGE AND FAMILY THERAPY LICENSURE BOARD