Provider Demographics
NPI:1609604016
Name:ULRICH, TREVOR AARON (CBLC)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:AARON
Last Name:ULRICH
Suffix:
Gender:
Credentials:CBLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 GODWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6335
Mailing Address - Country:US
Mailing Address - Phone:910-403-6106
Mailing Address - Fax:
Practice Address - Street 1:56 DODGE LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-8731
Practice Address - Country:US
Practice Address - Phone:919-403-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes175T00000XOther Service ProvidersPeer Specialist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty