Provider Demographics
NPI:1699462275
Name:BULLARD, ELIZABETH JOYCE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOYCE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOYCE
Other - Last Name:CUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8914 RAVEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1684
Mailing Address - Country:US
Mailing Address - Phone:812-212-3253
Mailing Address - Fax:
Practice Address - Street 1:17714 KINGS POINT DR STE B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6929
Practice Address - Country:US
Practice Address - Phone:812-212-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health