Provider Demographics
NPI:1801948104
Name:ULLERUP, BRUCE (LCSW)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ULLERUP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-1030
Mailing Address - Country:US
Mailing Address - Phone:828-253-0643
Mailing Address - Fax:828-225-2531
Practice Address - Street 1:14 HORSESHOE TRAIL
Practice Address - Street 2:
Practice Address - City:BARNARDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28709
Practice Address - Country:US
Practice Address - Phone:828-253-0643
Practice Address - Fax:828-225-2531
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002090Medicaid
NC12945OtherBCBS