Provider Demographics
NPI:1700198934
Name:BULLOCK, DORA PARKER (LPC)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:PARKER
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 WIND CHIME CT STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6511
Mailing Address - Country:US
Mailing Address - Phone:919-277-0253
Mailing Address - Fax:919-277-4627
Practice Address - Street 1:182 WIND CHIME CT STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6511
Practice Address - Country:US
Practice Address - Phone:919-277-0253
Practice Address - Fax:919-277-4627
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional