Healthcare Provider Details

I. General information

NPI: 1326590647
Provider Name (Legal Business Name): ROBIN J MULLICAN, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 OAK HALL LN SUITE 118
COLUMBIA MD
21045-5846
US

IV. Provider business mailing address

PO BOX 6234
COLUMBIA MD
21045-6234
US

V. Phone/Fax

Practice location:
  • Phone: 443-847-0100
  • Fax:
Mailing address:
  • Phone: 443-847-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04066
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04066
License Number StateMD

VIII. Authorized Official

Name: DR. ROBIN J MULLICAN
Title or Position: LICENSED PSYCHOLOGIST, OWNER
Credential: PSY.D.
Phone: 443-847-0100