Healthcare Provider Details

I. General information

NPI: 1447805726
Provider Name (Legal Business Name): CARLA DENISE MULLINS LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 BLAND RD
RALEIGH NC
27609-6239
US

IV. Provider business mailing address

8521 PERRY PINES DR APT 304
RALEIGH NC
27616-3565
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-1441
  • Fax: 919-872-1455
Mailing address:
  • Phone: 919-749-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP013955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: