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General NPI Number Information
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NPI Number | 1326569583
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Entity Type | Individual
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Provider Name | LORIE MULLAN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 119 SADER DR STE 4
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City | INWOOD
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State | WV
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Zip | 25428-3915
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Country | US
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Telephone | 304-278-3010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 92
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City | INWOOD
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State | WV
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Zip | 25428-0092
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Country | US
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Telephone | 304-278-3010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904014782
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00944804
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License Number State | WV
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