Provider Demographics
NPI:1740077460
Name:GRULLON, CHRISTINE A (CMSW, LCSWA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:GRULLON
Suffix:
Gender:
Credentials:CMSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 KYLEMAYNE CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5586
Mailing Address - Country:US
Mailing Address - Phone:973-919-8935
Mailing Address - Fax:
Practice Address - Street 1:1880 N BROAD ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3657
Practice Address - Country:US
Practice Address - Phone:919-557-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0218811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical