Individual
KENDRA RENEE BULLOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-2273
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
26340
MD
1041C0700X
Clinical Social Worker
Primary
95175
CA
Other
Enumeration date
09/10/2020
Last updated
10/04/2023
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