Provider Demographics
NPI:1346055993
Name:BULL, MIKELL DESMOND (MA, ST)
Entity type:Individual
Prefix:
First Name:MIKELL
Middle Name:DESMOND
Last Name:BULL
Suffix:
Gender:M
Credentials:MA, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BRAVES AVE APT 2438
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3374
Mailing Address - Country:US
Mailing Address - Phone:770-696-8617
Mailing Address - Fax:
Practice Address - Street 1:44 BRAVES AVE APT 2438
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3374
Practice Address - Country:US
Practice Address - Phone:770-696-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor