Basic Information
| Provider Information | |||||||||
| NPI: | 1144582024 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANGELA BROWN BULLA LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 S MAIN AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337653937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273284672 | ||||||||
| FaxNumber: | 7272879302 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 S MAIN AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337653937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277848244 | ||||||||
| FaxNumber: | 7272879302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROWN BULLA | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 7273284672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | SW 10862 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.