Provider Demographics
NPI:1770734477
Name:BULLOCK, JULIE CARPENTER (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:CARPENTER
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4922
Mailing Address - Country:US
Mailing Address - Phone:919-488-0015
Mailing Address - Fax:919-277-0066
Practice Address - Street 1:500 GATEWAY DR
Practice Address - Street 2:ATTN: JULIE BULLOCK, LCSW
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2158
Practice Address - Country:US
Practice Address - Phone:919-488-0015
Practice Address - Fax:919-488-1719
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007695Medicaid
NC6008736Medicaid