Roderick Conley Bullock

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

3104 Mintleaf Drive
Charlotte, NC 28269

Phone

(704) 519-8264

NPI assigned

Apr 23, 2008

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1932374766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 MINTLEAF DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282693069",
            "telephone_number": "704-589-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 MINTLEAF DRIVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28269",
            "telephone_number": "704-519-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "RODERICK",
        "middle_name": "CONLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Bullis
• Landon Rae Bulloch, M.D.
• Kiara Bullock
• Luke Bullock
• Meagan Marie Bullock, LCSWA
• Theodore Joseph Bullock, D.C.
• Trish N Bullock, PHARMD
• Alicia Bullough, PA-C
• Anna Bulsa
• Martha Bumgardner, RPH

• Addiction (Substance Use Disorder) Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.