| Doctor Name: | TINA BULLOCK |
| NPI Number: | 1275714032 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 70 S Water St East Windsor, CT - 060886600 |
| Business Phone Number: | 8606233039 |
| Business Fax Number: | 8602921518 |
| Mailing Address: | 41 Highland Ave, ELLINGTON |
| State: | CT |
| Postal Code: | 060293796 |
| Phone Number: | 8604540279 |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2007 |
| NPI Last Update Date: | 11/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |