Healthcare Provider Details

I. General information

NPI: 1497415202
Provider Name (Legal Business Name): ANDREA MULLINS LPCA, TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 HIGHWAY 3410
MAYKING KY
41837-9065
US

IV. Provider business mailing address

1003 HIGHWAY 3410
MAYKING KY
41837-9065
US

V. Phone/Fax

Practice location:
  • Phone: 606-335-0407
  • Fax:
Mailing address:
  • Phone: 606-335-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number285857
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number285920
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: