Provider Demographics
NPI:1942289137
Name:BOBO, JUDITH K (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:K
Last Name:BOBO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W KIME ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3854
Mailing Address - Country:US
Mailing Address - Phone:336-227-8412
Mailing Address - Fax:336-227-1793
Practice Address - Street 1:108 W KIME ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3854
Practice Address - Country:US
Practice Address - Phone:336-227-8412
Practice Address - Fax:336-227-1793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC428106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1313WOtherBLUECROO/BLUESHIELD PROVI