Provider Demographics
NPI:1215770938
Name:TRULUCK, MARY WARD (BACHELORS DEGREE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:WARD
Last Name:TRULUCK
Suffix:
Gender:F
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3013
Mailing Address - Country:US
Mailing Address - Phone:843-697-0599
Mailing Address - Fax:
Practice Address - Street 1:825 DILIGENCE DR UNIT 102
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4211
Practice Address - Country:US
Practice Address - Phone:254-249-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-24-355221106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician