Provider Demographics
NPI:1851642169
Name:BULLOCK, MEAGAN MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MARIE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1246
Mailing Address - Fax:704-384-6072
Practice Address - Street 1:1900 RANDOLPH RD
Practice Address - Street 2:SUITE 800
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1122
Practice Address - Country:US
Practice Address - Phone:704-384-1246
Practice Address - Fax:704-384-6072
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0076351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical