Bertha Delois Bullock, LCSWA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

P023264 Issued in NC

Practice address

2472 Tonoloway Dr
Raleigh, NC 27610-7190

Phone

(252) 739-6641

Fax

(252) 739-6641

NPI assigned

Mar 9, 2026

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1174479588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2472 TONOLOWAY DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276107190",
            "telephone_number": "919-790-7775",
            "fax_number": "919-790-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2472 TONOLOWAY DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276107190",
            "telephone_number": "252-739-6641",
            "fax_number": "252-739-6641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "BERTHA",
        "middle_name": "DELOIS",
        "name_prefix": "Miss",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-03-09",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "P023264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Bullard
• Ashley Lisa Bullen
• John Andrew Bullington Jr., RN, ANP
• Angelique Bullock
• Benita Bullock
• Dora Parker Bullock, LPC
• Joseph McNeill Bumgarner, MD
• Mary Kathryn Jenkins Bumgarner, PA-C
• Morgan Elizabeth Bumgarner
• Laketa Bumpers

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.