Individual
JESSICA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCADC, MA, CCS
Contact information
Practice address
2 SOUTH AVE E STE 200, CRANFORD, NJ 07016-2811
(732) 770-5627
Mailing address
821 N WOOD AVE, LINDEN, NJ 07036-4037
(908) 290-3550
(732) 626-6365
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37PC00529500
NJ
Other
Enumeration date
02/26/2014
Last updated
02/19/2025
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