Provider Demographics
NPI:1821264680
Name:BULLOCK, TAMIKA (LPC,NCC, MBA)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LPC,NCC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S NEW YORK RD STE 21
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6025
Mailing Address - Country:US
Mailing Address - Phone:609-992-4849
Mailing Address - Fax:609-939-1265
Practice Address - Street 1:311 S NEW YORK RD STE 21
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-6025
Practice Address - Country:US
Practice Address - Phone:609-992-4849
Practice Address - Fax:609-939-1265
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00353200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional