Provider Demographics
NPI:1023022126
Name:HUGHES, DAVID BRUCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 BROOKSIDE GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7420
Mailing Address - Country:US
Mailing Address - Phone:804-301-5910
Mailing Address - Fax:
Practice Address - Street 1:3333 WRIGHTSVILLE AVE STE G112
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4115
Practice Address - Country:US
Practice Address - Phone:480-613-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090062721041C0700X
NCC0134811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010101107Medicaid
VA010101085Medicaid