Provider Demographics
NPI:1710167051
Name:PULLEY, CAROL K (MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:K
Last Name:PULLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:50 MITCHELL RIVER RIDGE
Mailing Address - City:ROARING GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28668-0056
Mailing Address - Country:US
Mailing Address - Phone:828-964-8790
Mailing Address - Fax:336-363-3202
Practice Address - Street 1:189 SAMARITANS RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2472
Practice Address - Country:US
Practice Address - Phone:828-964-8790
Practice Address - Fax:888-544-6736
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3453103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical