Provider Demographics
NPI:1750939518
Name:BULKA, ANNA ROSE (AMFT, SUDCC IV)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:ROSE
Last Name:BULKA
Suffix:
Gender:
Credentials:AMFT, SUDCC IV
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:WOLTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANNA WOLTERS
Mailing Address - Street 1:1601 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1345
Mailing Address - Country:US
Mailing Address - Phone:619-432-2479
Mailing Address - Fax:
Practice Address - Street 1:1601 PRECISION PARK LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92173-1345
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-205-4100
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10844101YA0400X
CA153510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)