Provider Demographics
NPI:1093143091
Name:BULLOCK, TAMEKA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 REDWOOD BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5812
Mailing Address - Country:US
Mailing Address - Phone:240-299-5985
Mailing Address - Fax:
Practice Address - Street 1:7105 REDWOOD BRANCH CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-5812
Practice Address - Country:US
Practice Address - Phone:240-299-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical