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NPI Code Detail

MEDICARE: MS. JULIE NICOLE MULLIGAN CAC-ADP

MEDICARE: MS. JULIE NICOLE MULLIGAN CAC-ADP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2390200000XStudent in an Organized Health Care Education/Training ProgramADT542MD

General Provider Information

NPI Number : 1649533001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE NICOLE MULLIGAN CAC-ADP
Provider Business Mailing Address
First Line : PO BOX 980
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-0980
Country : US
Telephone Number : 410-535-3079
Fax Number : 410-535-2220
Provider Business Practice Location Address
First Line : 280 STAFFORD RD
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-3582
Country : US
Telephone Number : 410-535-3079
Fax Number : 410-535-2220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2012
Last Update Date : 08/25/2016

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