| Doctor Name: | MS. GLENDA BULLOCK-WILLIS |
| NPI Number: | 1386073237 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC3872 |
| Business Practice Address: | 6201 Greenbelt Rd Suite U4 Berwyn Heights, MD - 207402354 |
| Business Phone Number: | 3018326295 |
| Business Fax Number: | |
| Mailing Address: | 9715 Luria Ln, LANHAM |
| State: | MD |
| Postal Code: | 207063311 |
| Phone Number: | 3018326295 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2013 |
| NPI Last Update Date: | 11/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC3872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |