Basic Information
Provider Information | |||||||||
NPI: | 1801569561 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MULLINS COUNSELING, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 56 HUGHES RD UNIT 2183 | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | AL | ||||||||
PostalCode: | 357586593 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3346528299 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9238 MADISON BLVD STE 800 | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | AL | ||||||||
PostalCode: | 357589165 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2562587777 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2021 | ||||||||
LastUpdateDate: | 07/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MULLINS | ||||||||
AuthorizedOfficialFirstName: | GINA | ||||||||
AuthorizedOfficialMiddleName: | DIANE | ||||||||
AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR | ||||||||
AuthorizedOfficialTelephone: | 3346528299 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LPC | ||||||||
NPICertificationDate: | 07/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 1760947808 | 01 |   | NPPES | OTHER |