Healthcare Provider Details

I. General information

NPI: 1700833258
Provider Name (Legal Business Name): EUGENIA LEE GULLICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 FAIRVIEW RD SUITE #200
CHARLOTTE NC
28210-3289
US

IV. Provider business mailing address

6201 FAIRVIEW RD SUITE #200
CHARLOTTE NC
28210-3289
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-9940
  • Fax: 704-844-8826
Mailing address:
  • Phone: 704-366-9940
  • Fax: 704-844-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: