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General NPI Number Information
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NPI Number | 1700936481
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Entity Type | Individual
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Provider Name | WILLIAM RONALD PULLIAM L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 722 GREENFIELD MOUNTAIN FARM
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City | AFTON
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State | VA
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Zip | 22920-2830
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Country | US
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Telephone | 434-361-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 722 GREENFIELD MOUNTAIN FARM
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City | AFTON
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State | VA
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Zip | 22920-2830
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Country | US
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Telephone | 434-361-9214
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701003025
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License Number State | VA
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