Provider Demographics
NPI:1912891987
Name:RUBIO-BUSTAMANTE, MISTY (LCMHCA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:RUBIO-BUSTAMANTE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 STATON MILL RD
Mailing Address - Street 2:
Mailing Address - City:STOKES
Mailing Address - State:NC
Mailing Address - Zip Code:27884-9765
Mailing Address - Country:US
Mailing Address - Phone:252-367-4028
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4879
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health