Individual provider Active NPI

Christina Marie Bullard, LMHC

  • Mental Health Counselor
  • Brockton, MA
National Provider Identifier
1831627801
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
10000329 Issued in MA
Practice address
1115 W Chestnut St
Brockton, MA 02301-7501
Phone
(508) 521-2287
NPI assigned
Jun 2, 2017
Last updated
May 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 10000329 MA Primary

Addresses

Primary practice location

1115 W Chestnut St
Brockton, MA 02301-7501

Mailing address

80 Erdman Way Ste 208
Leominster, MA 01453-1840
Phone (800) 244-4691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240125001527 MA Practitioner - Mental Health Counselor 2860845914 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10000329MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
South Bay Mental Health Center, Inc. CurrentSince Jan 1, 2024 Accepting new patients
SB Transitional Sub, LLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

103 Commercial St
Ste 2
Brockton, MA 02302

1115 W Chestnut St
Brockton, MA 02301
Phone (508) 559-0473

80 Erdman Way
Ste 208
Leominster, MA 01453
Phone (978) 840-8900

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1831627801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 ERDMAN WAY STE 208",
            "city": "LEOMINSTER",
            "state": "MA",
            "postal_code": "014531840",
            "telephone_number": "800-244-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "508-521-2287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-02",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "10000329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.