Provider Demographics
NPI:1801305222
Name:BOBO, JUANITA (LPC, LCMHC)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:BOBO
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SW MAYNARD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4472
Mailing Address - Country:US
Mailing Address - Phone:919-822-8286
Mailing Address - Fax:
Practice Address - Street 1:119 SW MAYNARD RD STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4472
Practice Address - Country:US
Practice Address - Phone:919-822-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health