MEDICARE: MELISSA M MULLINS LPC

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	101YP2500X	Professional Counselor	7871	NC
2	101YP2500X	Professional Counselor	6176	SC

General Provider Information

NPI Number	:	1952595951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA M MULLINS LPC

Provider Business Mailing Address
First Line	:	10906 FEATHERBROOK RD APT 2C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-7732
Country	:	US
Telephone Number	:	704-208-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 MAIN ST STE 140
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-5801
Country	:	US
Telephone Number	:	704-208-8013
Fax Number	:

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

Provider Enumeration Date	:	09/01/2007
Last Update Date	:	04/05/2024

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