Basic Information
| Provider Information | |||||||||
| NPI: | 1366919425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | NICY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 BLUE PINE DR | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283909176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546300401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 ARSENAL AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233368 | ||||||||
| FaxNumber: | 9104910833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2018 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 12085A | NC | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 2302 | NC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.