Individual
CAROL ANNE GULLO-JENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
324 LOUISA AVE, SUITE 118, VIRGINIA BEACH, VA 23454-4669
(757) 333-7797
(757) 333-7760
Mailing address
324 LOUISA AVE, SUITE 118, VIRGINIA BEACH, VA 23454-4669
(757) 333-7797
(757) 333-7760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000456
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063739
ANTHEM BCBS OF VA
VA
01
—
226446000
MAGELLAN
VA
05
—
8910197
—
VA
01
—
O80372
SENTARA OPTIMA HEALTH CAR
VA
Enumeration date
07/18/2006
Last updated
07/18/2012
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