Jennifer Ashby Bullock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004353 Issued in NC

Practice address

1318 Broad St
Durham, NC 27705-3533

Phone

(919) 741-0726

Fax

(919) 479-8172

NPI assigned

Jan 31, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1326226465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6220 CABIN BRANCH DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277129089",
            "telephone_number": "919-741-0726",
            "fax_number": "919-479-8172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 BROAD ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053533",
            "telephone_number": "919-741-0726",
            "fax_number": "919-479-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JENNIFER",
        "middle_name": "ASHBY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002827",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martine Heather Bullard, MT-BC, NMT
• Susan Alice Bullard, PHARM.D.
• Clark Bulleit
• Andrea Bullock
• Brittany Kiera Bullock, MSW, LCSWA
• William Michael Bullock, M.D., PH.D.
• Brian Bumgardner
• Julia Bumpus, RD
• Anthony Tyrone Bunch, P.A
• Caitlin Elizabeth Bunch, OTR/L

• Clinical Social Worker in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.