Provider Demographics
NPI:1912603556
Name:PULLER, JOCELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:PULLER
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 1:5932 COVERDALE WAY APT G
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-5414
Mailing Address - Country:US
Mailing Address - Phone:703-409-1592
Mailing Address - Fax:
Practice Address - Street 1:8350 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2300
Practice Address - Country:US
Practice Address - Phone:703-409-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000022451041C0700X
VA09040148691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical