Individual
BEVERLY H BULLOCK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3300 ACADEMY AVE, ACADEMY CROSSING MEDICAL PLAZA, PORTSMOUTH, VA 23703-3205
(757) 483-6404
(757) 483-0737
Mailing address
3300 ACADEMY AVE, ACADEMY CROSSING MEDICAL PLAZA, PORTSMOUTH, VA 23703-3205
(757) 483-6404
(757) 483-0737
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000619
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081306
SENTARA
VA
01
—
242116
ANTHEM
VA
05
—
8904570
—
VA
Enumeration date
09/13/2005
Last updated
07/08/2007
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