Bullock, Beverly H
Bullock, Beverly H is an individual health care provider with primary practice located at 3300 Academy Ave Academy Crossing Medical Plaza, Portsmouth VA 23703-3205. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bullock, Beverly H can be contacted via phone (757) 483-6404.Contact Information
Primary practice address
3300 Academy Ave Academy Crossing Medical Plaza
Portsmouth VA 23703-3205
Phone: (757) 483-6404
Fax: (757) 483-0737
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 0904000619 | Virginia |
Profile Details
| NPI number | 1558356857 |
|---|---|
| LBN Legal business name | Bullock, Beverly H |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558356857 | NPPES |
| Virginia | Other | 242116 | ANTHEM |
| Virginia | MEDICAID | 8904570 | ANTHEM |
| Virginia | Other | 081306 | ANTHEM |
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