Provider Demographics
NPI:1376153338
Name:BULSZA, ROBERT J (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BULSZA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 50046
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0001
Mailing Address - Country:US
Mailing Address - Phone:843-902-0023
Mailing Address - Fax:
Practice Address - Street 1:GRAND STRAND BUSINESS CENTER
Practice Address - Street 2:1293 PROFESSIONAL DR, SUITE 109
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5754
Practice Address - Country:US
Practice Address - Phone:843-333-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional