Healthcare Provider Details

I. General information

NPI: 1346546934
Provider Name (Legal Business Name): CORY MULLINS LMSW QIDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 GLENEAGLES
HIGHLAND MI
48357-4781
US

IV. Provider business mailing address

1185 GLENEAGLES
HIGHLAND MI
48357-4781
US

V. Phone/Fax

Practice location:
  • Phone: 248-895-1455
  • Fax:
Mailing address:
  • Phone: 248-895-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092551
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: