Individual
TINA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
70 S WATER ST, EAST WINDSOR, CT 06088-6600
(860) 623-3039
(860) 292-1518
Mailing address
41 HIGHLAND AVE, ELLINGTON, CT 06029-3796
(860) 454-0279
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/21/2007
Last updated
11/21/2007
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