Provider Demographics
NPI:1679272546
Name:BULAN, ALYSSA (LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BULAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 MCCABE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7026
Mailing Address - Country:US
Mailing Address - Phone:804-482-0583
Mailing Address - Fax:
Practice Address - Street 1:2002 BREMO RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2441
Practice Address - Country:US
Practice Address - Phone:804-482-0583
Practice Address - Fax:804-525-9580
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional