Provider Demographics
NPI:1851495444
Name:BULLARD, DONNA MCCALL (MA LPC LPA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MCCALL
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MA LPC LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305
Mailing Address - Country:US
Mailing Address - Phone:910-476-8611
Mailing Address - Fax:
Practice Address - Street 1:1617B OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-484-3330
Practice Address - Fax:910-484-3301
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4051101YP2500X
NC1813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107101Medicaid
NC131XCOtherBCBS NC