Provider Demographics
NPI:1184160426
Name:PULLINGS, RETNA MAE (JD, CACII, MAC)
Entity type:Individual
Prefix:
First Name:RETNA
Middle Name:MAE
Last Name:PULLINGS
Suffix:
Gender:F
Credentials:JD, CACII, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 NEWTON ST NW
Mailing Address - Street 2:B1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3100
Mailing Address - Country:US
Mailing Address - Phone:202-459-1207
Mailing Address - Fax:
Practice Address - Street 1:1477 NEWTON ST NW
Practice Address - Street 2:B1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3100
Practice Address - Country:US
Practice Address - Phone:202-459-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1025101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health