Provider Demographics
NPI:1962874461
Name:BULLOCK, WHITNEY NICOLE (LCSWA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LCSWA
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 345
Mailing Address - Street 2:
Mailing Address - City:BATTLEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27809-0345
Mailing Address - Country:US
Mailing Address - Phone:252-883-8056
Mailing Address - Fax:
Practice Address - Street 1:148 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5501
Practice Address - Country:US
Practice Address - Phone:252-212-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical