Provider Demographics
NPI:1851360903
Name:BULLMAN, REBECCA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BULLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 GEIST RD
Mailing Address - Street 2:SUITE E 304
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3549
Mailing Address - Country:US
Mailing Address - Phone:907-479-7657
Mailing Address - Fax:
Practice Address - Street 1:FAIRBANKS COUNSELING AND ADOPTION
Practice Address - Street 2:912 BARNETTE STREET
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709
Practice Address - Country:US
Practice Address - Phone:907-456-4729
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical