Bullock, Mary Alisa

Bullock, Mary Alisa is an individual health care provider with primary practice located at 1104A S Main St , Lexington NC 27292-3134. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Bullock, Mary Alisa can be contacted via phone (336) 242-2450.

Contact Information

Primary practice address
1104A S Main St Lexington NC 27292-3134
Phone: (336) 242-2450
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 25659 North Carolina
Behavioral Health & Social Service Providers / Mental Health 101YM0800X A14910 North Carolina
Behavioral Health & Social Service Providers / Professional 101YP2500X 14910 North Carolina
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LCAS-25659 North Carolina

Profile Details

NPI number 1902458037
LBN Legal business name Bullock, Mary Alisa
Credentials LPCA, LCASA, NCC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2019
Last updated Dec 1st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902458037 NPPES
North Carolina Other 101YP2500X STATE OF NC
North Carolina Other 101YA0400X STATE OF NC

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