Healthcare Provider Details

I. General information

NPI: 1396657805
Provider Name (Legal Business Name): LESTER LAMAR BULLARD JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 GREEN FARM RD
DANVILLE VA
24540-0320
US

IV. Provider business mailing address

410 GREEN FARM RD
DANVILLE VA
24540-0320
US

V. Phone/Fax

Practice location:
  • Phone: 434-425-9541
  • Fax:
Mailing address:
  • Phone: 434-425-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019725
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: