Healthcare Provider Details

I. General information

NPI: 1295823912
Provider Name (Legal Business Name): DAVID R. MULLEN MSW., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 NORTHEAST BLVD
CLINTON NC
28328-2023
US

IV. Provider business mailing address

7634 FIRETHORN DR
FAYETTEVILLE NC
28311-9215
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-7030
  • Fax: 910-592-1630
Mailing address:
  • Phone: 910-592-7030
  • Fax: 910-592-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002115
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3350
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: