Alicia Marie Bullock, LCSWA, LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P007477 Issued in NC

Practice address

284 Executive Park Dr
Suite 100
Concord, NC 28025-1831

Phone

(704) 939-1100

Fax

(704) 939-1173

NPI assigned

Aug 7, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1669729877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10338 SAMUELS WAY DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787629",
            "telephone_number": "252-799-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251831",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "ALICIA",
        "middle_name": "MARIE",
        "credential": "LCSWA, LCASA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P007477",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "2976A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Adams Buckley, FNP
• Carl Louis Buckner, MD
• Ryan Michael Buddendeck, DDS
• Joelle Buitendorp
• Sean Michael Buitendorp, DPT
• Brittany Rae Bullock, PHARMD
• Selah R Bullock
• Betsy J Bumbarger, ATC L
• Jennifer B. Bunch, DO
• Ryan Thomas Bunch, DO

• All providers in Concord, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.