Provider Demographics
NPI:1053636936
Name:MCMULLEN, ANDREA M (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 COURTHOUSE DRIVE
Mailing Address - Street 2:P.O. BOX 299
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9370
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-525-1073
Practice Address - Street 1:3375 US RT 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-0069
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-586-0671
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009434721041C0700X
WV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WVDP00943472OtherLICENSE
WV9122342Medicare PIN
9122432Medicare UPIN