Healthcare Provider Details

I. General information

NPI: 1164098497
Provider Name (Legal Business Name): LUCA PULLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA PULLIAM

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 NC 24-87
CAMERON NC
28326-6752
US

IV. Provider business mailing address

511 BLANEY CT
HOPE MILLS NC
28348-9298
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-113938
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4250
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: