MEDICARE: NIKI AMIA MULLIS MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2400	NC

General Provider Information

NPI Number	:	1093374365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKI AMIA MULLIS MA, LMFT

Provider Business Mailing Address
First Line	:	2223 NEW GARDEN RD APT D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2359
Country	:	US
Telephone Number	:	704-953-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 ADMIRAL DR STE 105A
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1554
Country	:	US
Telephone Number	:	336-673-5097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	02/05/2026

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