Provider Demographics
NPI:1295857795
Name:BUSH, TONI M (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 CHATELAINE PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7272
Mailing Address - Country:US
Mailing Address - Phone:919-562-1011
Mailing Address - Fax:919-562-5125
Practice Address - Street 1:2904 CHATELAINE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7272
Practice Address - Country:US
Practice Address - Phone:919-562-1011
Practice Address - Fax:919-562-5125
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional