Individual
ABIGAIL ROSE LEI BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4531 SE BELMONT ST STE 317, PORTLAND, OR 97215-1693
(503) 389-0030
Mailing address
4531 SE BELMONT ST STE 317, PORTLAND, OR 97215-1693
(503) 389-0030
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C10900
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336024496
NPI 2
OR
05
—
500792702
—
OR
05
—
500873529
—
OR
01
—
C10900
LICENSE
OR
Enumeration date
04/22/2021
Last updated
06/03/2026
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