Provider Demographics
NPI:1003483926
Name:MULLINS, CRYSTAL BROCK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:BROCK
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6971
Mailing Address - Country:US
Mailing Address - Phone:865-936-9230
Mailing Address - Fax:
Practice Address - Street 1:THE SANCTUARY
Practice Address - Street 2:300 TYLER ROAD, SUITE 203
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-245-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW00000043041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical