Provider Demographics
NPI:1225205420
Name:TULLIS, CHARLES L JR (LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:TULLIS
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 FLAT SHOALS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1509
Mailing Address - Country:US
Mailing Address - Phone:770-474-6682
Mailing Address - Fax:
Practice Address - Street 1:2178 HIGHWAY 138 E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2219
Practice Address - Country:US
Practice Address - Phone:770-474-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist