Individual
MS. CHRISTINA M BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LPC, NCC
Contact information
Practice address
252 CALLOWAY CT, EVANS, GA 30809
(870) 243-7514
(870) 933-9395
Mailing address
252 CALLOWAY CT, EVANS, GA 30809
(870) 243-7514
(870) 933-9395
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P1201007
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169571795
—
AR
01
—
5AA34
BCBS
AR
Enumeration date
05/13/2008
Last updated
03/03/2022
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