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General NPI Number Information
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NPI Number | 1932504933
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Entity Type | Organization
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Legal Business Name | CORY J MULLINS, LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 1711 CASS LAKE RD
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City | KEEGO HARBOR
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State | MI
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Zip | 48320-1047
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Country | US
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Telephone | 248-895-1455
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Fax | 248-481-4352
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Provider Business Mailing Address
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Address Line | 1711 CASS LAKE RD
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City | KEEGO HARBOR
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State | MI
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Zip | 48320-1047
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Country | US
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Telephone | 248-895-1455
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Fax | 248-481-4352
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Authorized Official
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Title or Position | CEO, THERAPIST
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Name | MR. CORY J MULLINS
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Credential | LMSW QIDP
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Telephone | 248-895-1455
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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 |
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License Number State |
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