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General NPI Number Information
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NPI Number | 1700468287
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Entity Type | Individual
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Provider Name | BRENDA EILEEN MULLIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2021
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 5501 FORTUNES RIDGE DR STE P
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City | DURHAM
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State | NC
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Zip | 27713-6102
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Country | US
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Telephone | 919-391-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 5948 ROUNDER LN
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9683
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Country | US
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Telephone | 919-608-2905
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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 | C008561
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License Number State | NC
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