Provider Demographics
NPI:1467790253
Name:BUSHAIJA, JUDITH BATAMULIZA (MSW LCSWA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:BATAMULIZA
Last Name:BUSHAIJA
Suffix:
Gender:F
Credentials:MSW LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 DREW HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6949
Mailing Address - Country:US
Mailing Address - Phone:574-360-2226
Mailing Address - Fax:
Practice Address - Street 1:200 S POLLOCK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-3062
Practice Address - Country:US
Practice Address - Phone:574-360-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0071431041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical