Healthcare Provider Details

I. General information

NPI: 1568212926
Provider Name (Legal Business Name): ALEX BUMGARDNER LCSW-A, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SHEPPARD BRANCH RD
WEAVERVILLE NC
28787-9506
US

IV. Provider business mailing address

PO BOX 2083
SKYLAND NC
28776-2083
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-29181
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP019218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: