Provider Demographics
NPI:1356049985
Name:BULLOCK, MICHELLE ELAINE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 ARTESIA RD
Mailing Address - Street 2:
Mailing Address - City:HALLSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28442-9196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3309
Practice Address - Country:US
Practice Address - Phone:910-297-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health