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General NPI Number Information
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NPI Number | 1679170724
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Entity Type | Individual
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Provider Name | JOSEPH E BULLOCK JR. LCPC,LPC
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Gender | Male
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 11903 NEWTOWN RD
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City | NEWTOWN
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State | VA
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Zip | 23126-2041
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Country | US
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Telephone | 703-615-2582
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 863
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City | SEVERN
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State | MD
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Zip | 21144-0863
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Country | US
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Telephone | 703-615-2582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14807
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCO877
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License Number State | MD
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