Healthcare Provider Details

I. General information

NPI: 1811699325
Provider Name (Legal Business Name): RANDI MULLINS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WHITESTICK ST
MABSCOTT WV
25871-0046
US

IV. Provider business mailing address

235 WHITESTICK ST
MABSCOTT WV
25871-0046
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-8709
  • Fax: 304-254-8719
Mailing address:
  • Phone: 304-254-8709
  • Fax: 304-254-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2372-4346
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: