Provider Demographics
NPI:1194120022
Name:PULLEN, CHERI
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SEBASTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9099
Mailing Address - Country:US
Mailing Address - Phone:252-314-5616
Mailing Address - Fax:
Practice Address - Street 1:220 SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9099
Practice Address - Country:US
Practice Address - Phone:252-314-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional