Provider Demographics
NPI:1477230837
Name:PULLIAM, ADRIANNA MARIE (TLLP)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:MARIE
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28303 DEQUINDRE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3040
Mailing Address - Country:US
Mailing Address - Phone:248-658-1116
Mailing Address - Fax:
Practice Address - Street 1:28303 DEQUINDRE RD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3040
Practice Address - Country:US
Practice Address - Phone:248-658-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI6362009776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other