Individual
CHARLA RENEE BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATR-BC, LPAT
Contact information
Practice address
1500 E WOODROW WILSON AVE # 117, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE # 117, JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
PAT0008
MS
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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