Provider Demographics
NPI:1679170724
Name:BULLOCK, JOSEPH E JR (LCPC,LPC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:BULLOCK
Suffix:JR
Gender:M
Credentials:LCPC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-0863
Mailing Address - Country:US
Mailing Address - Phone:703-615-2582
Mailing Address - Fax:
Practice Address - Street 1:8757 THORNBROOK DR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3409
Practice Address - Country:US
Practice Address - Phone:703-615-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14807101YP2500X
MDLCO877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional