Individual
WANDA PULLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
843 N AUGUSTA AVE, BALTIMORE, MD 21229-1823
(443) 829-4562
Mailing address
843 N AUGUSTA AVE, BALTIMORE, MD 21229-1823
(443) 829-4562
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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