Most Relevant Information
Provider Data
| NPI Number: | 1003043696 |
| Provider Name: | CHESTER WAYNE BULLOCK PSYD, MED |
| Entity Type: | Individual |
| Taxonomy Code: | 103T00000X |
| Specialty: | Psychologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/22/2009 |
| Last Updated: | 06/10/2022 |
Provider Practice Location
910 17TH ST NW STE 419
WASHINGTON
DC
200062605
Practice Location Phone/Fax
| Phone: | 2025052795 |
| Fax: |
Provider Mailing Location
910 17TH ST NW STE 419
WASHINGTON
DC
200062605
Provider Mailing Phone/Fax
| Phone: | 2025052795 |
| Fax: |