| Organization Name: | BUSH CLINICAL AND CONSULTATIVE SERVICES PLLC |
| NPI Number: | 1093033268 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRYSTAL DENEE BUSH (OWNER) |
| Mailing Address: | 101 Industrial Dr Louisburg |
| State: | NC US |
| Postal Code: | 275492307 |
| Phone Number: | 8772584795 |
| Fax Number: | 8665839593 |
| NPI Enumeration Date: | 05/12/2010 |
| NPI Last Update Date: | 02/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |