MEDICARE: TESA MULLINS LCSW

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
1	1041C0700X	Clinical Social Worker	0904013717	VA

General Provider Information

NPI Number	:	1902550288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESA MULLINS LCSW

Provider Business Mailing Address
First Line	:	5705 LYNNHAVEN PKWY STE 104
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-9157
Country	:	US
Telephone Number	:	740-577-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4313 NEW ORLEANS WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-1537
Country	:	US
Telephone Number	:	740-577-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	04/27/2023

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