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Individual
MR. MARK B BULLOCK
Active
Individual
MR. MARK B BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C4410
OR
Other
Enumeration date
05/26/2010
Last updated
03/06/2017
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