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General NPI Number Information
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NPI Number | 1326590647
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Entity Type | Organization
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Legal Business Name | ROBIN J MULLICAN, PSYD, LLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 6851 OAK HALL LN SUITE 118
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City | COLUMBIA
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State | MD
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Zip | 21045-5846
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Country | US
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Telephone | 443-847-0100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6234
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City | COLUMBIA
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State | MD
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Zip | 21045-6234
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Country | US
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Telephone | 443-847-0100
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST, OWNER
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Name | DR. ROBIN J MULLICAN
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Credential | PSY.D.
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Telephone | 443-847-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04066
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04066
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License Number State | MD
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