Provider Demographics
NPI:1952526360
Name:BULLARD, DAVID CHRISTIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTIAN
Last Name:BULLARD
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Mailing Address - Street 1:3320 ROBINHOOD RD
Mailing Address - Street 2:PMB #302
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5404
Mailing Address - Country:US
Mailing Address - Phone:336-659-2448
Mailing Address - Fax:336-659-2449
Practice Address - Street 1:2830 MAPLEWOOD AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4114
Practice Address - Country:US
Practice Address - Phone:336-659-2448
Practice Address - Fax:336-659-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000595Medicaid
NC2821308BMedicare PIN