Provider Demographics
NPI:1770237786
Name:CONSTANCE W. PULLEN
Entity Type:Organization
Organization Name:CONSTANCE W. PULLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-822-6501
Mailing Address - Street 1:25800 AVONIA LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21662-1417
Mailing Address - Country:US
Mailing Address - Phone:410-822-6501
Mailing Address - Fax:
Practice Address - Street 1:25800 AVONIA LN
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MD
Practice Address - Zip Code:21662-1417
Practice Address - Country:US
Practice Address - Phone:410-822-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD160241100Medicaid