Provider Demographics
NPI:1437484680
Name:GULLA, LORI (MS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GULLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2841
Mailing Address - Country:US
Mailing Address - Phone:336-378-0708
Mailing Address - Fax:336-378-0728
Practice Address - Street 1:114 N ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2841
Practice Address - Country:US
Practice Address - Phone:336-378-0708
Practice Address - Fax:336-378-0728
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional